August 26, 2011 OHA Director's messages on the web
To: All OHA employees
From: Bruce Goldberg, M.D., Director

Rebooting Health Care

"Almost always, the creative dedicated minority has made the world better." ~ Martin Luther King, Jr.

Like many people, I have a smaller and less expensive computer than I did 10 years ago. The machine I use now has features that were unimaginable a decade ago. In fact, my old PC would be better suited as a museum piece than a useful tool. The exponential leap forward has happened in large part because innovation is driven by customer satisfaction and cost effectiveness. There's a culture in high-tech of doing things better, faster, and providing products at a lower cost.

There are lessons to be learned from this as we work to transform the Oregon Health Plan. We know what we want - better health. We don't simply want more medical care, more medicine, more hospitalization. In fact, we want to be healthy and to take less medicine. We want better health. But our system pays for office visits, pills and ER care, so that's what is provided. When it comes to health care, we have a built in incentive for bulk orders of gold-plated floppy disks.

When health care costs are increasing faster than inflation, they unnecessarily suck resources from other important endeavors. There is no one to blame for this, it's a system issue. Employers lose dollars they could be investing to increase their workforces. Families lose dollars from their household budgets and paychecks. And our agency has to make difficult choices about who gets services and how much we can afford to pay for them.

We have to turn things around. One of the most important elements of the transformation under way is a fundamental change in the way we pay for health care services. That comes from looking at health care more globally - across the health spectrum - and planning budgets accordingly. Today there are more than two dozen revenue streams that pay for services for OHP clients and coordination between them is either difficult or nonexistent. That means waste and inefficiency, and creates unnecessary barriers to better health. And, we don't make the investments needed in the short term to improve health and save dollars down the road.

But, a global budget is not simply about costs. It's about the outcomes we get from our health care system and the accountability for achieving them. We will not succeed if we are driven by dollars alone. Disks are cheap but inadequate when it comes to computing. In the same way, care that is simply cheap, won't keep people healthier and might actually increase costs for the long term.

For local Coordinated Care Organizations, success will mean bringing creativity and innovation to their approach. We need to have new ways to improve health and invest accordingly at a price we can afford. That will bring a greater focus on preventive care and chronic illness management. In some communities it could mean investments in school based health clinics. In others, greater outreach for arthritis care. And n others, drug and alcohol treatment. These decisions would happen at the local level and OHA would both provide flexibility with funding and accountability for outcomes.

The details of how global budgets will be set up are being discussed at one of the four HB 3650 work groups set up by Governor Kitzhaber and the Oregon Health Policy Board. You can follow this group and others at

Over the next few months, both in these groups and in coming public forums, we'll continue the discussion changing the status quo for better health, better care, and lower costs. It's a very exciting time in our state. We are building a foundation so that ten years from now, we will look back on our current health care system and wonder how we were ever able to make it work.

OHA on the web