One of the little discussed features of the Affordable Care Act (better known in some circles, for better or worse, as Obamacare) is the authorization of federal funds to be given to states so that they can set up test programs that experiment with ways to reduce Medicaid costs. One such program is underway in Oregon and is receiving positive preliminary reviews.
The program establishes “coordinated care organizations” to care for populations of Medicaid patients in each city in Oregon. These organizations consist of the main providers of medical care: hospitals, physicians, mental health professionals, and dentists, and links them together electronically so they can share information. Receipients are then able to go wherever they can receive the best care. The organizations are paid a lump sum to care for the Medicaid population. It is hoped that significant cost savings can be achieved by incentivizing efficient care.
One of the more interesting features of the program is the use of $20-an-hour outreach workers to help the sickest Medicaid patients navigate the system and avoid costly hospitalizations. Each outreach worker is assigned about 30 patients and helps the patient keep current on their medications, seek appropriate primary care when necessary, and learn about their conditions. Currently, many Medicaid recipients in Oregon are homeless and often allow their chronic medical conditions to deteriorate until they seek medical care in the emergency room. Anecdotal evidence suggests that some outreach workers have enabled select Medicaid recipients to reduce their average annual emergency room visits from 10 to 4. Avoiding even one emergency room visit or hospitalization would more than pay the salary of the outreach worker and pass significant savings on to the Medicaid system, to say nothing of the improved quality of life of the Medicaid recipient. The results are far from in, and the plan has its opponents as well, but Oregon’s is an experiment worth watching.