By Bennett Hall
Sitting in an exam room at Benton Family Medicine, 8-year-old Lauro Ramirez Lira gingerly picked at the animal-print Band-Aid on his upper right arm, where he'd just had a shot. Asked if it hurt, the sturdy second-grader solemnly shook his head.
"We like this place," his mother, Maria Guadalupe Lira of Albany, said in Spanish with help from a bilingual medical assistant. "The people are very nice."
Benton Family Medicine is one of four federally funded clinics in the mid-valley operated by the Benton County Health Department. In most respects, it looks like any other busy medical office, with a waiting room full of patients and a staff of doctors, nurses and technicians bustling about.
But there's something else going on here, and it's called integration.
In addition to a wide range of medical care, patients can access a host of other services - from mental health to addiction treatment to nutrition counseling - all delivered through a team approach with a focus on prevention and disease management. Referrals to specialists outside the county's treatment network are coordinated through the clinic, which is moving toward a centralized records system so that all providers involved in an individual's care are aware of the person's complete health history.
"We've really pushed the integration efforts," said Sherlyn Dahl, who runs the county clinics.
"What we're really trying to do is redesign our program from the patient's perspective so they can come in the door and, no matter what they need, our providers can get that for them, and we can do that seamlessly."
If you want to know what the future of health care in Oregon looks like, this just might be it.
The notion of an integrated "health home" that helps people manage the full spectrum of their health care needs is central to an ambitious reform effort launched in 2007 by the passage of Senate Bill 329.
Dubbed the Healthy Oregon Act, SB 329 created a seven-member panel, the Oregon Health Fund Board. Its members are developing a plan to ensure that all Oregonians have access to health care while containing costs and improving quality. A comprehensive reform proposal is to be presented to the 2009 Legislature for a vote.
Since May 1, members of the Oregon Health Fund Board have been soliciting public opinion on the reform plan with a series of town hall-style meetings around the state. The last one is scheduled for Thursday night in Corvallis (see box on A1).
In the meantime, the broad outlines of the reform proposal have been taking shape through the work of six subcommittees. What's beginning to emerge is a sweeping restructuring of the state's health care system.
"This is the most comprehensive approach to health care reform since the Oregon Health Plan," said Corvallis reform activist Betty Johnson, who sits on the Benefits Committee. Johnson is one of seven mid-valley residents with a subcommittee post.
While the Oregon Health Plan would remain in place for the state's poorest residents, the reform plan would revamp the insurance market to cover the more than 600,000 Oregonians who are currently uninsured. Employer-provided plans also would remain in force, as would Medicare and other federal programs.
In a departure from the current market-based approach, no one could be denied coverage regardless of pre-existing health conditions, and everyone would be guaranteed access to a comprehensive set of defined benefits. People who fall below a certain income level would get state assistance to cover the premium.
"Whoever your insurance provider might be would be required to provide at least that foundational level of benefits," said Benton County Health Department Administrator Tom Eversole, another Benefits Committee member.
The menu of covered services will likely be based on the list established for the Oregon Health Plan, which Eversole said is far more extensive than most people realize.
"There's a stigma with Medicaid and OHP," he said. "But if you look at it, it's pretty good."
To keep costs down, some medical services will have to be left off the guaranteed benefits list, a fact that is sure to spark complaints of rationing. But Ellen Gradison, a Corvallis lawyer who serves on the Federal Laws Committee, said such objections are misplaced in a system that relies to a large extent on public funding.
"Rationing - that's a real dirty word in a lot of areas. It makes people stop thinking and get real emotional," Gradison said. "You've got to remember that a lot of the money involved in this is tax dollars."
No cost estimates for the plan are available yet, but everyone agrees the bill is going to be steep if the goal is to assure all Oregonians access to comprehensive health care services.
Dr. Mike Huntington, a retired radiologist from Adair Village, worries that the Legislature will balk at the price tag.
"The question is can we afford to cover all those who need subsidies," said Huntington, a member of the Federal Laws Committee.
"No matter what we come up with, cost is the big elephant in the living room," agreed Johnson. But, she added, "everything can be done if you have the will to do it."
The Oregon Health Fund Board is considering a variety of cost-containment measures, including setting a fixed fee schedule for common medical procedures and creating a statewide buying pool for medications.
But one of the fundamental principles of the reform effort is the notion that there's already enough money in the health care system - we just need to find smarter ways to spend it.
That's what the "health home" concept is all about.
Proponents of the idea argue that centralizing health care administration will create a cascade of efficiencies that will siphon significant expense out of the system. The integrated approach also facilitates health screenings, preventive care and management of chronic diseases such as diabetes, which can head off serious and costly problems before they become critical.
According to Dahl, that approach is starting to pay off at Benton Family Medicine in the most important way - with healthier patients.
"Just in the last several months we can really begin to see some real results," Dahl said. "We're in the early stages, but we're pretty committed to trying to make a change."
Oregon's latest attempt at health care reform is being watched closely at the national level, where a host of proposals are being discussed to rescue a system widely viewed as broken. Committee members hope the work they're doing now will lead to a model that could be adopted across the country.
"If we can really tackle this and do a decent job of it," Johnson said, "then eventually maybe the federal government will do what it ought to be doing."
Bennett Hall can be reached at 758-9529 or bennett.hall@lee.net.