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Bates, Buckley talk health care reform at town hall

Faced with another giant revenue shortfall, two valley legislators beat the drum Monday at a town hall meeting for creation of locally controlled coordinated care organizations.

These CCOs would speed delivery of a range of health services — substance recovery, mental health, dental and long-term care — to the 20 percent of Oregon Health Plan members who use 80 percent of its resources.

Staring down the barrel of a $107 million revenue shortfall, the Legislature in its upcoming February session will hold the line in the vital areas of early childhood education, economic development and health care, said Rep. Peter Buckley, D-Ashland, noting that medical costs are "increasing at a rate we can't afford — 15 to 20 percent a year."

Sen. Alan Bates, D-Medford, said the shortfall is one of the worst in the nation, though not as drastic as California's and Washington's, and state legislators "don't know how to fix it."

The two lawmakers spoke to a town hall meeting at the Medford Library Monday night.

A big step toward corralling runaway medical costs will be forming the CCOs authorized by House Bill 3650. The organizations would allow practitioners in many fields to "tear down their silo walls" and coordinate efforts for preventive care in areas of substance abuse and mental health counseling, thus reducing overall spending and keeping high-risk poor patients out of emergency rooms and hospitals.

"Seventy percent (of costs) are from lifestyle — obesity, smoking, lack of exercise," said Bates, a physician. "There are laws that prevent (practitioners in each field) from talking to each other. So much of illness is driven by smoking and substance abuse. These people need to get out of their silos and talk to each other. It's the way it's done in all other countries."

Mental health patients, said Bates, often are sent to the state hospital, which costs $289,000 a year per person, and "burns up tax dollars without taking care of them properly" — or they are hospitalized, which is $10,000 a day.

The CCOs, already starting up in some counties but just getting under way in Jackson County, are operated by local boards of directors and put all their revenues, including Medicaid, in one pot, said Bates. He said the new law penalizes hospitals or doctor groups who opt out of the system — and it will save up to $600,000 for local governments.

"People naturally get nervous," said Bates, if revenues are put in one pot, but it relieves local governments of "being left holding the bag" for the high cost of caring for the mentally ill.

Members of the audience of about 50 complained about cuts to areas they work in, one noting that cuts to drug treatment and drug courts result in higher spending in corrections and other areas. Circuit Judge Ron Grensky said earlier state cuts have impaired out-of court settlements, leading to more expensive jury trials — and the system cannot endure any further cuts.

Buckley agreed that cuts mean the justice system "will cost more in the long run," and Bates added that with corrections more expensive now than higher education, "we've got to give judges discretion in adjusting sentences."

The new law calls for creating CCOs for the Oregon Health Plan next July.

John Darling is a freelance writer living in Ashland. E-mail him at jdarling@jeffnet.org.