ARTICLE
A healthier economy: Why strong healthcare is key to the region's well being from the April / May issue of OPEN for Business Magazine, a publication of the Eugene Area Chamber of Commerce view as a PDF Pop quiz: What two private sector job categories employ the most people in Lane County? Give yourself a high five if you said “retail trade.” That catch-all category, which includes all food and beverage stores in addition to general merchandise and clothing stores, employed 20,800 Lane County workers in 2015, tops among private nonfarm job categories, according to the Oregon Employment Department. How about No. 2? Leisure and hospitality, with 15,800 jobs, would be a good guess. But it would be wrong. Manufacturing? Close, but no cigar. The No. 2 private employer in Lane County is health care, with 19,500 jobs. That represents almost 16 percent of all jobs in the county, and health care employment is still expanding. State Employment Department projections for Lane County through 2022 forecast that health care and social assistance will add 3,800 jobs, the most of any sector, largely due to a growing and aging population. Those jobs pay pretty well, to boot. At an average annual wage of about $53,000, health care pay is 31 percent higher than the $40,280 annual average for Lane County overall. From major medical facilities to rural county clinics, health care is a cornerstone of Lane County’s economy. High wages notwithstanding, consider what recent and ongoing health care construction has pumped into the area’s building trades and professional services payrolls: McKenzie-Willamette Medical Center’s renovation and expansion in Springfield: $80 million The new Veterans Affairs clinic on Chad Drive in Eugene: $50 million PeaceHealth’s $13.6 million inpatient Behavioral Health Services unit (opened in late 2014) and $2.7 million Emergency Department renovation on the University District campus in Eugene: $16.3 million Oregon Medical Group’s clinic on County Club Road in Eugene: $7 million Willamette Valley Cancer Institute’s remodeling and addition on County Club Road: $4.6 million The hard-dollar impact of health care is only part of the story. In addition to family-wage jobs, capital construction, income and property taxes, utility payments and a host of other direct financial contributions, health care organizations are increasingly mobilizing considerable resources toward keeping people healthy. “Wait a minute,” you might be saying. “Haven’t health care organizations always tried to keep people healthy?” Granted, your primary care provider has likely always tried to help you understand how nutrition, lifestyle and exercise choices affect your health, for better or for worse. But the Affordable Care Act and new reimbursement rules from the federal Centers for Medicare and Medicaid Services have upped the ante big time on the need for health care organizations to focus on preventing illness, hospitalization and unnecessary visits to emergency rooms. This represents a significant change from mainly concentrating on taking care of people when they’re sick. “In a large and more global way, making the population healthier has huge economic impacts,” says Chris Overton, Senior Director of Kaiser Permanente’s Lane County Service Area. Underscoring the link between community health and economic health, PeaceHealth’s Rand O’Leary adds, “Lost productivity from sick days is just one example of how these two sectors are related. Keeping people healthy and cultivating a ‘whole body wellness’ help make businesses and communities work better.” O’Leary is President of Hospital Services for PeaceHealth in Oregon. The big transition: Moving from volume to value The six Lane County health care leaders interviewed for this article are all in the midst of guiding their organizations through a transition from a system that has based reimbursement on the number of patients treated and services provided to one that includes incentives for keeping people healthy while getting more bang for the bucks being spent. In addition to Overton and O’Leary, Chad Campbell at McKenzie-Willamette Medical Center, Terry Coplin at Trillium Community Health Plan, Chris Achtien at Willamette Valley Cancer Institute and Research Center, and Cris Noah at Oregon Medical Group agree that the new paradigm, often described as moving “from volume to value,” is changing health care delivery in Lane County. For one thing, it requires health care organizations to remain connected with their patients after they’ve left the clinic or hospital and returned to where they live or moved to another care setting. “We expect to see continued work among providers to help patients with continuity of care between health care settings,” says Campbell, CEO at McKenzie-Willamette Medical Center. That places a premium on communication and collaboration among health care organizations, something that has been more of a hit-or-miss proposition in the past. “We’re now managing patient care even when patients aren’t coming into the office,” says Noah, CEO of Oregon Medical Group. “We are reaching out to patients who need screenings, immunizations, and disease management in order to help them live healthier lives.” Noah is describing a key feature of what many in the health care industry call “population health management.” It refers to managing the clinical health outcomes of a group of patients with the goal of improving their overall health while lowering the cost of care. A good example is having someone from the clinic call patients at home after they have had an annual physical in which they’ve been prescribed medication to control their blood pressure. The caller checks to see if the patients have actually filled their prescription and if they understand how to take the medication. Such outreach is inexpensive and doesn’t require the expertise of a physician. Just imagine the potential savings if this kind of personalized follow-up avoided a disastrous health consequence, such as a patient having a stroke as a result of failing to take their medication. Though individual organizations may define population health differently, it is often linked to the Triple Aim, which outlines three overarching goals for health care: improving the individual experience of care, reducing the per capita cost of care, and improving the health of populations. Much of what people think of as “health care reform” is encompassed broadly in the Triple Aim. Oregonians can doubtless find ample reason to support each of the Triple Aim’s goals, but reducing the cost of care may have the most immediate allure. Health care spending in Oregon grew 7.5 percent last year, the seventh-fastest growth rate in the United States. Nationally, health care spending grew 6.5 percent during the same time frame, to $9,523 per person, by far the highest of any industrialized nation. As a share of the U.S. Gross Domestic Product, health spending accounted for 17.5 percent last year, almost double what was spent in the United Kingdom. Hospital expenses chew up the largest chunk of Oregon’s health care spending at 33.6 percent. Physician and other professional services take 30.6 percent, and prescription drugs and other nondurable medical expenses tally 12.5 percent. A half-dozen smaller categories make up the rest. Coordinated care organizations: Population health writ large One of the nation’s most ambitious initiatives to control health care costs and improve the overall delivery of care was launched in Oregon under the direction of former Gov. John Kitzhaber. Oregon became a national leader in health care transformation by establishing coordinated care organizations (CCOs) as the delivery system for Medicaid patients who receive coverage under the Oregon Health Plan (OHP). A coordinated care organization is a network of all types of health care providers (physical health care, addictions and mental health care, and sometimes dental care providers) who have agreed to work together in their local communities to serve OHP clients. CCOs are focused on prevention and helping people manage chronic conditions, like diabetes. This helps reduce unnecessary emergency room visits and gives people support to be healthy. CCOs are accountable for meeting health outcome and financial targets in their respective service areas. Today, there are 16 CCOs operating in communities around Oregon, including Trillium Community Health Plan in Lane County. In addition to serving OHP clients, Trillium also offers Medicare Advantage plans and coverage through the national health care exchange, Healthcare.gov. Trillium CEO Terry Coplin is justifiably proud of the success of Lane County’s CCO, but is quick to acknowledge an unexpected consequence of Trillium’s 72 percent growth in membership when Medicaid eligibility was expanded in Oregon. There simply were not enough primary care providers in Lane County to accommodate the influx of newly insured residents. It’s a national problem, complicated by the looming retirement of Baby Boom generation physicians. One in three practicing physicians in the United States is over the age of 65 and close to retirement. Sixty percent of physicians recently surveyed say it is likely many of their colleagues will retire in the next one to three years. Coplin realized that additional investment was necessary to help alleviate the provider shortage. “In 2014, we invested nearly $1 million to help Lane County open a community health clinic, the Brookside clinic at 7th Avenue and Chambers,” he says. “In 2015, we gave the county $1 million to open another community health clinic, the Delta Oaks clinic in the Delta Oaks shopping center. We also gave nearly $1 million to Springfield Family Physicians to open Centennial Clinic, their second primary care clinic in Springfield. Since our launch as a coordinated care organization, Trillium has invested a total of $11.75 million in the community by expanding provider capacity, and funding prevention initiatives focusing on tobacco, obesity and mental health.” In addition to investments in primary care capacity, Trillium has launched the Trillium Integration Incubator Project. This innovative effort is funding eight provider pilot projects that will guide Trillium toward the best delivery system models for the integration of physical health and behavioral health. Willamette Valley Cancer Institute and Research Center also is responding to the need to develop new models of care that improve clinical outcomes for cancer patients or help keep them out of the hospital. “We have applied to be one of 100 practices nationwide to participate in a five-year pilot project, providing cancer care to Medicare patients,” says Chris Achtien, Executive Director of WVCI. “We have a good chance at being chosen, and we’ll know more in the coming weeks.” Providing more providers Despite the investments by Trillium and other health care organizations in Lane County, access to primary care and high demand for age-related care promise to present ongoing challenges. “As the Baby Boom generation ages, we will see higher demand for age-related and elder care programs, including joint replacement, heart and vascular, and outpatient rehabilitation services,” says PeaceHealth’s O’Leary. One strategy embraced by all Lane County health care organizations involves hiring more advanced practice clinicians—physician assistants and nurse practitioners—to support physicians and expand access. Of course, PAs and NPs are in high demand nationally for just that reason, though Lane County continues to successfully recruit these high-level care providers. “Employing advanced practice providers allows our oncologists more time to focus on what they do best,” says WVCI’s Achtien. “Our center recently added two advanced practice providers, and we’re in the process of recruiting two more to become part of our physician-led teams.” Another care model that is credited with increasing the capacity of existing practices to handle more patients is the “medical home.” Though the definition, like most things in health care, varies depending on organizational philosophy or clinical approach, at its most basic level, a medical home is a team-based approach to primary care. In a typical medical home model, patients are seen by teams that may include medical assistants, care coordinators, nurses, nurse practitioners, physician assistants, behavioral health specialists and physicians. The idea behind medical homes is that patients can receive effective support for many of their primary care needs from a variety of health care professionals. It isn’t necessary to see a physician in every office encounter. “We’re expanding our primary care medical home teams,” says OMG’s Noah. “We see teams as one way to design more efficient workflows and care processes to improve access and reduce provider burnout.” Forecasting the future: What’s ahead for health care? If you had to pick a single word that every Lane County health care leader used to sum up the changes patients are likely to see in the next three to five years, it would be: technology. Put the prefix “tele” in front of a service, and before long it will be coming to a digital screen near you: telemedicine, telestroke, telepsychiatry, teleconsult. For Kaiser’s Overton, the future is already here. The new Kaiser clinic in Eugene began scheduling virtual visits on Feb. 15. “We have a goal of ultimately having 50 percent of our visits be virtual,” Overton says. “We expect you’ll have access to specialists and you’ll be able to interact in real time through your mobile device or computer.” PeaceHealth and Trillium both expect to see an acceleration of the integration of behavioral health and physical health in the primary care setting, as well as expanded treatment options for patients with more complex behavioral health needs. “The most recent Lane County Community Health Needs Assessment listed improving mental health resources as a top priority for community health,” PeaceHealth’s O’Leary says. “We are proud of the work we are doing in this area and plan to continue to develop and expand our Behavioral Health Services programs in the years ahead.” McKenzie-Willamette and Oregon Medical Group both anticipate an expansion of care coordination throughout the health care system, including better communication and handoffs among organizations caring for the same patients. Increasing integration of electronic health records will help make this possible. Helping to restore economic health Virtual visits and whiz-bang technology aside, it’s also clear that Lane County’s health care organizations will play an increasingly important role in restoring the region’s economic health. Ongoing facility construction and expanding payrolls contribute to a positive prognosis for growth. The availability of high-quality health care also is important to businesses interested in locating here, and it’s a vital tool for recruiting the best and brightest job candidates in a national marketplace. To a person, local health care leaders acknowledge how fortunate Lane County residents are that an area this size is able to attract the caliber of health care professionals it does, absent a major university medical program or teaching hospital. In the bigger picture, Lane County’s talented and dedicated health care professionals offer area residents something of even greater value: hope and healing during times of need, and the peace of mind that comes with knowing all but the most specialized care is available right here, close to home.
A healthier economy: Why strong healthcare is key to the region's well being from the April / May issue of OPEN for Business Magazine, a publication of the Eugene Area Chamber of Commerce view as a PDF Pop quiz: What two private sector job categories employ the most people in Lane County?
Give yourself a high five if you said “retail trade.” That catch-all category, which includes all food and beverage stores in addition to general merchandise and clothing stores, employed 20,800 Lane County workers in 2015, tops among private nonfarm job categories, according to the Oregon Employment Department.
How about No. 2? Leisure and hospitality, with 15,800 jobs, would be a good guess. But it would be wrong. Manufacturing? Close, but no cigar.
The No. 2 private employer in Lane County is health care, with 19,500 jobs. That represents almost 16 percent of all jobs in the county, and health care employment is still expanding. State Employment Department projections for Lane County through 2022 forecast that health care and social assistance will add 3,800 jobs, the most of any sector, largely due to a growing and aging population.
Those jobs pay pretty well, to boot. At an average annual wage of about $53,000, health care pay is 31 percent higher than the $40,280 annual average for Lane County overall.
From major medical facilities to rural county clinics, health care is a cornerstone of Lane County’s economy. High wages notwithstanding, consider what recent and ongoing health care construction has pumped into the area’s building trades and professional services payrolls:
The hard-dollar impact of health care is only part of the story. In addition to family-wage jobs, capital construction, income and property taxes, utility payments and a host of other direct financial contributions, health care organizations are increasingly mobilizing considerable resources toward keeping people healthy.
“Wait a minute,” you might be saying. “Haven’t health care organizations always tried to keep people healthy?” Granted, your primary care provider has likely always tried to help you understand how nutrition, lifestyle and exercise choices affect your health, for better or for worse. But the Affordable Care Act and new reimbursement rules from the federal Centers for Medicare and Medicaid Services have upped the ante big time on the need for health care organizations to focus on preventing illness, hospitalization and unnecessary visits to emergency rooms. This represents a significant change from mainly concentrating on taking care of people when they’re sick.
“In a large and more global way, making the population healthier has huge economic impacts,” says Chris Overton, Senior Director of Kaiser Permanente’s Lane County Service Area. Underscoring the link between community health and economic health, PeaceHealth’s Rand O’Leary adds, “Lost productivity from sick days is just one example of how these two sectors are related. Keeping people healthy and cultivating a ‘whole body wellness’ help make businesses and communities work better.” O’Leary is President of Hospital Services for PeaceHealth in Oregon.
The big transition: Moving from volume to value
The six Lane County health care leaders interviewed for this article are all in the midst of guiding their organizations through a transition from a system that has based reimbursement on the number of patients treated and services provided to one that includes incentives for keeping people healthy while getting more bang for the bucks being spent. In addition to Overton and O’Leary, Chad Campbell at McKenzie-Willamette Medical Center, Terry Coplin at Trillium Community Health Plan, Chris Achtien at Willamette Valley Cancer Institute and Research Center, and Cris Noah at Oregon Medical Group agree that the new paradigm, often described as moving “from volume to value,” is changing health care delivery in Lane County.
For one thing, it requires health care organizations to remain connected with their patients after they’ve left the clinic or hospital and returned to where they live or moved to another care setting. “We expect to see continued work among providers to help patients with continuity of care between health care settings,” says Campbell, CEO at McKenzie-Willamette Medical Center. That places a premium on communication and collaboration among health care organizations, something that has been more of a hit-or-miss proposition in the past.
“We’re now managing patient care even when patients aren’t coming into the office,” says Noah, CEO of Oregon Medical Group. “We are reaching out to patients who need screenings, immunizations, and disease management in order to help them live healthier lives.”
Noah is describing a key feature of what many in the health care industry call “population health management.” It refers to managing the clinical health outcomes of a group of patients with the goal of improving their overall health while lowering the cost of care. A good example is having someone from the clinic call patients at home after they have had an annual physical in which they’ve been prescribed medication to control their blood pressure. The caller checks to see if the patients have actually filled their prescription and if they understand how to take the medication. Such outreach is inexpensive and doesn’t require the expertise of a physician. Just imagine the potential savings if this kind of personalized follow-up avoided a disastrous health consequence, such as a patient having a stroke as a result of failing to take their medication.
Though individual organizations may define population health differently, it is often linked to the Triple Aim, which outlines three overarching goals for health care: improving the individual experience of care, reducing the per capita cost of care, and improving the health of populations. Much of what people think of as “health care reform” is encompassed broadly in the Triple Aim.
Oregonians can doubtless find ample reason to support each of the Triple Aim’s goals, but reducing the cost of care may have the most immediate allure. Health care spending in Oregon grew 7.5 percent last year, the seventh-fastest growth rate in the United States. Nationally, health care spending grew 6.5 percent during the same time frame, to $9,523 per person, by far the highest of any industrialized nation. As a share of the U.S. Gross Domestic Product, health spending accounted for 17.5 percent last year, almost double what was spent in the United Kingdom.
Hospital expenses chew up the largest chunk of Oregon’s health care spending at 33.6 percent. Physician and other professional services take 30.6 percent, and prescription drugs and other nondurable medical expenses tally 12.5 percent. A half-dozen smaller categories make up the rest.
Coordinated care organizations: Population health writ large
One of the nation’s most ambitious initiatives to control health care costs and improve the overall delivery of care was launched in Oregon under the direction of former Gov. John Kitzhaber. Oregon became a national leader in health care transformation by establishing coordinated care organizations (CCOs) as the delivery system for Medicaid patients who receive coverage under the Oregon Health Plan (OHP). A coordinated care organization is a network of all types of health care providers (physical health care, addictions and mental health care, and sometimes dental care providers) who have agreed to work together in their local communities to serve OHP clients. CCOs are focused on prevention and helping people manage chronic conditions, like diabetes. This helps reduce unnecessary emergency room visits and gives people support to be healthy. CCOs are accountable for meeting health outcome and financial targets in their respective service areas.
Today, there are 16 CCOs operating in communities around Oregon, including Trillium Community Health Plan in Lane County. In addition to serving OHP clients, Trillium also offers Medicare Advantage plans and coverage through the national health care exchange, Healthcare.gov.
Trillium CEO Terry Coplin is justifiably proud of the success of Lane County’s CCO, but is quick to acknowledge an unexpected consequence of Trillium’s 72 percent growth in membership when Medicaid eligibility was expanded in Oregon. There simply were not enough primary care providers in Lane County to accommodate the influx of newly insured residents. It’s a national problem, complicated by the looming retirement of Baby Boom generation physicians. One in three practicing physicians in the United States is over the age of 65 and close to retirement. Sixty percent of physicians recently surveyed say it is likely many of their colleagues will retire in the next one to three years.
Coplin realized that additional investment was necessary to help alleviate the provider shortage.
“In 2014, we invested nearly $1 million to help Lane County open a community health clinic, the Brookside clinic at 7th Avenue and Chambers,” he says. “In 2015, we gave the county $1 million to open another community health clinic, the Delta Oaks clinic in the Delta Oaks shopping center. We also gave nearly $1 million to Springfield Family Physicians to open Centennial Clinic, their second primary care clinic in Springfield. Since our launch as a coordinated care organization, Trillium has invested a total of $11.75 million in the community by expanding provider capacity, and funding prevention initiatives focusing on tobacco, obesity and mental health.”
In addition to investments in primary care capacity, Trillium has launched the Trillium Integration Incubator Project. This innovative effort is funding eight provider pilot projects that will guide Trillium toward the best delivery system models for the integration of physical health and behavioral health.
Willamette Valley Cancer Institute and Research Center also is responding to the need to develop new models of care that improve clinical outcomes for cancer patients or help keep them out of the hospital. “We have applied to be one of 100 practices nationwide to participate in a five-year pilot project, providing cancer care to Medicare patients,” says Chris Achtien, Executive Director of WVCI. “We have a good chance at being chosen, and we’ll know more in the coming weeks.”
Providing more providers
Despite the investments by Trillium and other health care organizations in Lane County, access to primary care and high demand for age-related care promise to present ongoing challenges. “As the Baby Boom generation ages, we will see higher demand for age-related and elder care programs, including joint replacement, heart and vascular, and outpatient rehabilitation services,” says PeaceHealth’s O’Leary.
One strategy embraced by all Lane County health care organizations involves hiring more advanced practice clinicians—physician assistants and nurse practitioners—to support physicians and expand access. Of course, PAs and NPs are in high demand nationally for just that reason, though Lane County continues to successfully recruit these high-level care providers.
“Employing advanced practice providers allows our oncologists more time to focus on what they do best,” says WVCI’s Achtien. “Our center recently added two advanced practice providers, and we’re in the process of recruiting two more to become part of our physician-led teams.”
Another care model that is credited with increasing the capacity of existing practices to handle more patients is the “medical home.” Though the definition, like most things in health care, varies depending on organizational philosophy or clinical approach, at its most basic level, a medical home is a team-based approach to primary care. In a typical medical home model, patients are seen by teams that may include medical assistants, care coordinators, nurses, nurse practitioners, physician assistants, behavioral health specialists and physicians. The idea behind medical homes is that patients can receive effective support for many of their primary care needs from a variety of health care professionals. It isn’t necessary to see a physician in every office encounter.
“We’re expanding our primary care medical home teams,” says OMG’s Noah. “We see teams as one way to design more efficient workflows and care processes to improve access and reduce provider burnout.”
Forecasting the future: What’s ahead for health care?
If you had to pick a single word that every Lane County health care leader used to sum up the changes patients are likely to see in the next three to five years, it would be: technology. Put the prefix “tele” in front of a service, and before long it will be coming to a digital screen near you: telemedicine, telestroke, telepsychiatry, teleconsult.
For Kaiser’s Overton, the future is already here. The new Kaiser clinic in Eugene began scheduling virtual visits on Feb. 15. “We have a goal of ultimately having 50 percent of our visits be virtual,” Overton says. “We expect you’ll have access to specialists and you’ll be able to interact in real time through your mobile device or computer.”
PeaceHealth and Trillium both expect to see an acceleration of the integration of behavioral health and physical health in the primary care setting, as well as expanded treatment options for patients with more complex behavioral health needs. “The most recent Lane County Community Health Needs Assessment listed improving mental health resources as a top priority for community health,” PeaceHealth’s O’Leary says. “We are proud of the work we are doing in this area and plan to continue to develop and expand our Behavioral Health Services programs in the years ahead.”
McKenzie-Willamette and Oregon Medical Group both anticipate an expansion of care coordination throughout the health care system, including better communication and handoffs among organizations caring for the same patients. Increasing integration of electronic health records will help make this possible.
Helping to restore economic health
Virtual visits and whiz-bang technology aside, it’s also clear that Lane County’s health care organizations will play an increasingly important role in restoring the region’s economic health. Ongoing facility construction and expanding payrolls contribute to a positive prognosis for growth.
The availability of high-quality health care also is important to businesses interested in locating here, and it’s a vital tool for recruiting the best and brightest job candidates in a national marketplace. To a person, local health care leaders acknowledge how fortunate Lane County residents are that an area this size is able to attract the caliber of health care professionals it does, absent a major university medical program or teaching hospital.
In the bigger picture, Lane County’s talented and dedicated health care professionals offer area residents something of even greater value: hope and healing during times of need, and the peace of mind that comes with knowing all but the most specialized care is available right here, close to home.