County leading way on coordinated care

Many members of Thursday night’s Yamhill County Care Organization audiences in McMinnville and Newberg were dressed in medical scrubs, while carrots, tomatoes and broccoli were served for snacks.

That’s in keeping with YCCO’s mission — to deliver better health care at less cost to the county’s 16,000 Oregon Health Plan recipients. By ensuring more clients have family physicians to coordinate their care, and by improving communication and cooperation among providers, the goal is to cut costs 2 percent a year without sacrificing results.

YCCO hosted community forums in the county’s two largest cities Thursday to solicit ideas and share information on changes slated to go into effect Nov. 1. It’s all driven by a financial shortfall in the state budget, explained Dennis Gray, administrator at McMinnville’s Physicians Medical Center, at the McMinnville forum.

“The state had the option of cutting services, or we could figure out how to get control of the cost,” Gray said. He said the state won federal agreement to supplement the program, but in exchange, the state has to rein in its growing cost.

Essentially, Gray said, the state was given a pool of money and told to determine how to make it stretch far enough to meet needs.

County Commissioner Kathy George pledged her support.

She said it took her a while to get on board with the whole CCO concept, she said. “But as I’ve watched our providers come together and build this organization,” she said, “I’m really excited about it.”

Oregon is one of seven states chosen to pilot the program. They are charged with creating new mechanisms to control costs, and to do it without sacrificing critical services.

But according to Scott Clement of CareOregon, the response Yamhill County providers have taken is homegrown. He said it goes well beyond what state and federal officials are requiring.

“Yamhill County is unique in how this community really stepped up and led the effort,” he said. “It adds an element of excitement to this, and I’m glad to be involved. The energy and commitment dedicated to this is remarkable.”

Clement said the collaborative approach taken by local providers in response to the legislation is not representative of what’s going on around the state. It stands well above.

“You should be proud,” Clement told the audience. He said facing up to this challenge isn’t easy, but it is exciting.

The idea is to coordinate the care of every single Oregon Health Plan patient, ensuring care needs are handled at the earliest and thus least expensive level possible. If needs go unmet very long, they can escalate, forcing the state to provide invasive and expensive care in hospital settings.

One way YCCO plans to address that is to make it a priority for every client to have a primary care doctor in place. It is asking each family practice physician in the county to agree to accept 200 Oregon Health Plan patients, and most have made the pledge.

YCCO has embraced what it is calling a triple aim: “better health, better care, lower cost.” Board members think that can be best achieved by focusing on prevention and avoiding duplication, and prevention requires professional monitoring.

Michele Gray, a social worker with Head Start of Yamhill County, which provides preschool services to a predominately low-income clientele, said she came to the forum to learn more about how the changes would affect the families she serves.

She said one of Head Start’s goals is “to make sure every family has a medical and dental home.” And she said that goal is clearly charged by YCCO.

Dr. William Koenig, who serves as County Health Officer, served as forum facilitator. He said it’s going to take everyone working together to make resources stretch.

That includes not just doctors and nurses, but also pharmacists like Nicole Winnen, who owns the Mac Prescription Shop downtown.

Pharmacists are, by nature, coordinated care providers, she said. At least 30 times a day, she said, pharmacists at her shop advise customers on their medications, including ways to cut costs.

“We catch duplications all the time,” Winnen said. “A pharmacist knows better than anyone what medications cost.”

YCCO is currently recruiting members of the community for a Community Advisory Council it is creating, and Dr. Jim Rickards, a local radiologist serving on the YCCO board, told Winnen, “It sounds like you need an application. I think you would be a great asset.”

Applications can be obtained by contacting Katie Briedwell at briedwellk@co.yamhill.or.us