Oregon's test: Cut Medicaid costs while improving health care for poor

Sept. 6, 2014

By Lillian Thomas, Pittsburgh Post-Gazette

Portland, Ore. — Better — and cheaper — health care for the poor could lie in the answer to this question:

Can an air conditioner be considered medicine?

Janet Meyer, CEO of Health Share Oregon, says it can.

"There is the case of a guy with a heart problem," said Meyer, describing a patient who keeps going to the emergency department, where doctors stabilize him and send him home, only to return days later.

"Come to find out, he's in a walk-up with no AC — he has trouble managing his fluids," Meyer said. "We say, 'Maybe what he needs is an air conditioner.' Instead of going back and back to the ER, we buy him an air conditioner and help him manage his fluids."

The end result: Less money spent and the patient's health improved.

Health Share is part of an aggressive effort by Oregon to lower costs and improve medical care in its Medicaid system, a high-stakes undertaking that uses an unorthodox approach and is funded by a $1.9 billion waiver from the federal government that gives the state more flexibility.

The relentless economics of the U.S. health care system have sapped resources in poor areas for decades as hospitals and doctors follow the money in the form of well-insured patients. Doctors and medical care facilities serving large numbers of poor patients have trouble staying afloat because uninsured patients and those on Medicaid are expensive.

While most systems tried to skirt financial losses by avoiding those patients, a handful — from hospitals in Camden, N.J., to Philadelphia to those involved in the Oregon effort — have decided to focus on the poor, making them the centerpiece of efforts to spend less and give better care.

Oregon's effort is centered on the high utilizers — patients who show up frequently for emergency care and readmissions after hospitalization — among the approximately 971,000 people enrolled in its Medicaid program.