February 28, 2013
The health care reform conversation is happening nationwide, and OHSU executives, faculty and staff are regular contributors to the discussion. At the heart of the dialogue is how we can collectively reduce costs while improving care and the patient experience (achieve the Triple Aim). Below are a few recent articles of note. Continue the conversation by adding your feedback in the comments section below.
The Oregon ACO Experiment — Bold Design, Challenging Execution
Eric Stecker, M.D., MPH, assistant professor of medicine, in the New England Journal of Medicine
Here's an excerpt:
However, as committed as many Oregon stakeholders are to this experiment, there is a distinct possibility that it will fail. The state's proposal for the Oregon Health Plan to achieve savings and quality improvement without diminution of eligibility or benefits depends on a combination of improved administrative efficiencies and effective health care delivery reforms. The reform principles emphasized in the Oregon plan include expansion of disease-management programs; more flexible care, including expanded behavioral health services that are more integrated with physical health services; improved care coordination; and expansion of patient-centered medical homes.
Health Care Reform: The Impact on Academic Health Centers
OHSU President Joe Robertson, M.D., MBA, provides an in-depth perspective for Willamette Management Associate's Insights journal.
Here's an excerpt:
Health reform offers opportunities and challenges for academic health centers. As the process moves forward, we want to protect our ability to serve the public but we also want to contribute meaningfully to the process.
As community, regional, and sometimes national leaders, academic health centers are purposefully engaging in a fundamental re-design of our health care system. They are doing this, despite the fact that AHCs have been quite successful in the current system, because leadership in both health policy and practice is consistent with the mission and values of academic medicine. I believe we have a special obligation to lead change—developing new systems of care, new methods of training for providers, and more rapid ways to apply science.
As a nation, we are entering a moment in which far-reaching public sector imperatives are matched by grass roots efforts to improve care and outcomes. How exactly this all plays out has yet to be decided, but rest assured that academic health centers will continue to play a leading role.
Kilo, OHSU tackle health care costs
OHSU Chief Medical Officer Chuck Kilo, M.D., featured in Portland Business Journal
Dr. Kilo discusses Oregon’s coordinated care organizations, including the one in which OHSU is a partner: Health Share of Oregon. He also provides context for reform based on his past experience as CEO of Greenfield Health and vice president of the Institute for Healthcare Improvement. “It’s going to be a many-year experiment,” [Dr. Kilo] said. “It is very hard work, but it is the hard work that health care needs to do. It’s all about what’s best for the health of the citizens of Oregon, and what’s best for the economics of Oregon. To me those things go hand in hand.”
Focus on reducing hospital readmissions
An effort underway at OHSU aims to reduce hospital readmissions for patients at-risk for heart failure. Readmissions are not only costly (estimated at $17 billion a year for Medicare alone), they are undesirable for patients and providers alike. Since the Centers for Medicare & Medicaid began issuing financial penalties to hospitals with excess readmissions, facilities nationwide have put renewed effort into reducing readmissions. OHSU’s feasibility study exploring in-home monitoring for patients at risk for heart failure was featured in an Associated Press story printed in media outlets across the country. Jayne Mitchell, ANP, nurse practitioner for OHSU cardiology, is helping lead the program.
Here’s an excerpt from the Houston Chronicle:
In heart failure, a weakly pumping heart allows fluid to build up until patients gasp for breath. Spotting subtle early signs like swelling ankles or creeping weight gain is crucial. But at the Oregon Health & Science University, nurse practitioner Jayne Mitchell spied as patients were told what to watch for as they were discharged — and they barely paid attention.
The new plan: Learn by doing.
Every morning, hospitalized patients weigh themselves in front of a nurse, record the result and get quizzed on what they’d do at home. Gained 2 pounds or more? Call the doctor for fast help. Lots of day-to-day fluctuation? A weekly log can help a doctor tell if a patient is getting worse or skipping medication or having trouble avoiding water-retaining salty food.
And an exerpt from the Las Vegas Sun:
Pushed by those Medicare penalties, hospitals are getting the message.
“It’s made hospitals go, ‘Oh my gosh, just because they’re outside my door doesn’t mean I’m done,’” said nurse practitioner Jayne Mitchell of Oregon Health & Science University, who heads a new program to reduce readmissions of patients with heart failure.
In a pilot test, her hospital is sending special telemedicine monitors home with certain high-risk patients so that nurses can make a quick daily check of how these patients are faring in that first critical month.