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Health care reform is bold, important

The focus on prevention just makes good sense from the standpoint of both cost and health.

A bill approved last week in the Oregon Senate promises to save this state billions of dollars while simultaneously improving care for those people who need it most. Now, it's time for the House to sign off.

Senate Bill 1580, which would implement the concept of Community Care Organizations throughout the state, represents a fundamental change in how health care is delivered in Oregon.

Despite its daring nature, the principles underlying this latest version of health care reform are relatively straightforward. The idea is to slow the unsustainable growth in health care costs by doing a better job with preventive care, which in turn will dramatically reduce expensive hospitalizations.

Once the community care groups are in place (which could be as early as July in some areas), they will work to coordinate care for people on the Oregon Health Plan. The new system will integrate mental and physical health care - a particularly worthy reform for western Washington County, where mental-health issues are prominent and services fragmented.

Bruce Goldberg, director of the Oregon Health Authority, points out that under the current system of uncoordinated care, some people might go to emergency rooms 40 or 50 times a year for mental or physical issues. Just think how much money could be saved if those cases were treated in a doctor's office or clinic instead of the very expensive emergency room - or if underlying chronic diseases simply are managed better.

This focus on prevention just makes good sense from the standpoint of both cost and health. That's why Goldberg, Gov. John Kitzhaber and other supporters of the community-care concept have been successful in getting health care providers on board with an idea that ultimately could cost them revenues. It's also why the federal government apparently has signaled its willingness to help fund Oregon's experiment - the expectation is that those dollars will come back to the feds in the form of Medicaid savings.

The bill was nearly derailed by the malpractice debate last week but picked up a couple key Republican votes (include one from Hillsboro state Sen. Bruce Starr) and was sent to the House, where it's been stuck for several days.

We urge House members to pass it and set the community-care process in motion. At that point, the state must closely monitor how the new approach affects hospitals - particularly those in small communities, where a reduction in hospital revenue could threaten the only such institution in town.

For the metro area, the concern will be the speed of the proposed transformation and the ability of dozens upon dozens of providers to come to an agreement about how best to coordinate care for those who must rely on the Oregon Health Plan.

In the end, the transformation must be about more than Medicaid and the state-funded health plan. The emphasis on prevention also must become the basis for holding down health care costs for everyone - regardless of whether they have publicly funded health plans, private policies or employer-based insurance.

But as first steps go, this was a bold one that is taking Oregon in the right direction and, down the road, could serve as a model for other states to follow.



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