Oregon Department of Human Services Director's Message
Feb. 11, 2011 DHS Director's messages on the web
To: All DHS and OHA employees
From: Bruce Goldberg, M.D., Director

The expensive health care paradox

"Though no one can go back and make a brand new start, anyone can start from now and make a brand new ending."
~Author unknown

Our health care system is filled with paradox. We have developed a simple pill that cures a certain type of cancer, but you have to navigate through a very complex system to get it. We have the most advanced health technology and spend more on health care than any other nation in the world, yet we don't have the best health. New treatments are developed every day, yet too many of us go without care. We have new ways to treat and prevent cancer, but if you are an African American man your chance of dying from cancer is 32 percent higher than for your white peers; for African American women it's 16 percent higher.

And to top it all off, too often our health care can be impersonal, rushed and difficult to understand. For healers providing care and for those of us receiving it there is too much administrative red tape, as well as rules, permissions, approvals, bills we don't understand. It's not because anyone really wants it that way. No one planned it that way. But it's turned out that way, driven by a host of factors including the way health care providers are paid or not paid for some of the things that truly matter.

We cannot afford that any more. That is why the Governor and the Oregon Health Policy Board have convened more than 40 people from almost every aspect of health and health care, legislators, and community members. They are meeting every Wednesday evening to develop a plan for the Governor to remake the health care delivery system to be more personal, more affordable, and more accountable to actually improving our health.

For example, whenever possible, we should be working to keep people out of the hospital and to treat their needs before they require hospitalization. Hospital care is our most expensive kind of care and it is often avoidable. Some 40 percent of the cost of the Oregon Health Plan goes to pay for hospital-related costs. Often it is for conditions that could have been prevented if people had better care up front and if we made more investments in public health.

There are many models in the country that are successfully showing that something as simple and basic as the personal touch provided by community health workers can encourage people to take needed steps to better health and to avoiding more costly medical care. Similarly, medical homes, which are revolutionizing our primary care model by making it more patient centered, have been shown to decrease the need for emergency department visits by some 29 percent and hospital stays by 6 percent. An abscessed tooth can get fixed in the dentist's chair, for example, instead of in the Emergency Room after a serious infection has set in. This both improves health and saves public dollars.

We need to change the way we pay for care, paying for quality and outcomes not simply procedures. This can be accomplished by eliminating the cost shift that results from having widely disparate payment rates for the exact same care, and also by having a local point of accountability for care. Doctors, pharmacists, physical therapists, hospitals, all do a great job in their individual roles. But they often operate in silos and do not have connections to health information or accountability to each other and to a common community mission and purpose for improving our health and managing the financial resources that go into our health care system.

We cannot afford to go on this way. With our serious budget shortfall and health care costs eating up an ever increasing portion of the public dollar, we have to take action. The Health System Transformation Team will be delivering a plan to Governor Kitzhaber, the Legislature and the Oregon Health Policy Board by April. You can track the team's work through weekly updates on its website.

I have confidence that we are up to the challenges before us. Not only does Oregon have a track record of health care innovation, we also have a social model of care that we can take lessons from. In our state, we have changed long-term care for seniors and people with physical disabilities so that more people can live independently and fewer people go to expensive nursing homes. We do that by providing personal, cost-efficient supports in the home or in a small community setting.

We can learn from that model, expand it and better bring those successes into our larger health care system. We need to be connecting health care and long-term care in a more tangible way. Likewise we need to better connect and integrate mental health care and recovery, public health, health care and social supports to create the kind of system that works to keep us well and gets us the right care at the right time in a manner that works for us all.

That's how we meet our goals of improving the lifelong health of all Oregonians while lowering the cost of care.

DHS on the web