Health care eats up a lot of money. The aim of the Affordable Care Act is to help reduce the cost and increase access.
In Oregon, the state has embarked on an ambitious journey to improve health outcomes while trimming expenses. It’s being done through CCOs or Coordinated Care Organizations. One aspect is the use of community health workers, who visit patients in their homes to try and prevent costly trips to the emergency room.
KLCC’s Angela Kellner introduces us to one Springfield woman who now thinks of her community health worker as a son.
Skaggs: “Well, my name’s Caral Skaggs, recently moved back from Maui. I lived on Maui for a couple of years, came back because of my failing health.”
64-year-old Caral Skaggs sits on a bed in a Eugene rehabilitation center. Plastic tubes enter her nostrils, supplying a steady source of life-sustaining oxygen.
Skaggs: “I have COPD which is chronic lung disease. Too many years of smoking.”
Skaggs has been in and out of the hospital about every three months during the past several years. Each visit last about a week.
Skaggs: “For exacerbation, you know, choked up and can’t breathe, can’t get any air, air hunger they call it. Not a very pleasant thing to go through. But it does require hospitalization.”
Skaggs often feels weak and tired, so managing her chronic disease takes more energy than she has.
Rower: “My name’s John Rower and I’m a Community Health Worker.”
The 30-year-old is assigned to help Skaggs navigate the medical system. Rower began meeting with Skaggs at her home last fall. He has kept up those visits even when she was at the rehab center recovering from her most recent hospital stay.
Rower: “So how have you been feeling since you’ve been here?”
Skaggs: “Better, I’m a little better. I’m still not jumping around and I’m still not ready to go out and become a running back yet.”
Skaggs says Rower has been a godsend and has lifted her spirits enough to where she feels hopeful again.
Skaggs: “He’s been very kind, very generous with his time. He’s helped me out in so many ways. He has been my arbitrator, my agent. Getting things done, whereas I would put things off.”
Although Rower did some medic training with the Oregon Air National Guard, he’s in a non-clinical role as a community health worker. He does not provide medical care – he advocates for the patient to make sure they’re getting what they need and following doctors’ orders.
Rower: “We’re meeting people at very pivotal points in their life and some of the details that we’re privy to are very intimate and some things aren’t even shared with their closest family members.”
Rower makes about $15 an hour. That’s more cost effective than a full-time nurse or an ER visit. Those savings are key to Oregon’s grand plan to improve care and free up money for other budgetary needs such as education.
Governor John Kitzhaber, a former emergency room physician, has made a bet with the federal government to prove Oregon can transform health care. The state got $1.9-billion dollars to do it. The new Coordinated Care Organizations, or CCOs, give more control at the local level.
Kitzhaber: “So the CCOs are really focused on health. Their success, the metrics they have to meet are actually population health statistics right here in Lane County. So it’s very exciting. We’re changing the whole paradigm. And I think you’ll see this is going to be a model for the nation.”
The savings, Kitzhaber says, come from preventing the illness or disease from taking hold in the first place.
Kitzhaber: “It’s a model that basically depends on the ability to get in front of chronic illnesses, to manage those at home and a real focus on prevention. So they’re going where no man has gone before. They’re out at the edge of the map and they are pioneers.”
After six months in the field, does community health worker John Rower think its working?
Rower: “I believe completely that we’re on the right track. Not only is it going to save the taxpayer and the members of the community money in the long run, but I think more importantly it’s making the care that the individual’s receive more appropriate to their situation. It’s more personalized care.”
As for Skaggs, she’s proof that one person can make a difference. While she believes its Rower who’s made the difference, in the end, it will be Skaggs who is ultimately responsible for her health.
Skaggs: “If you have someone like John on your side you feel like there is an end, you don’t have to settle for things. And that’s what I was doing, I was settling for things. It’s like, okay, well that’s the way it is, that’s the way it is. But John has shown me that I don’t have to settle and that he will fight for me, so I should fight for myself.”
The Coordinated Care Organizations and Community Health Workers are one part of how the state is trying to be at the forefront of implementing President Obama’s health care overhaul. For Oregon, it’s do or die – if this fails, there won’t be another infusion of federal health care money. I’m Angela Kellner reporting.
Copyright 2013 Northwest Public Radio