Editorial: Churn is no substitute for health reform


Published Jul 11, 2013 at 05:00AM / Updated Nov 19, 2013 at 12:31AM

The Oregon Health Policy Board must be careful to avoid two deadly policy sins: overtretch and churn.

The board sets policy for the Oregon Health Authority and has also been asked by Gov. John Kitzhaber to develop new health reform policies for the state.

The board's goals are unquestionably good ones. It aims for improved health care quality. It aims for better patient access to care. And another goal is to keep it all affordable.

Oregon has already embarked on an ambitious health care transformation experiment to change the way care is delivered for Medicaid, through something called coordinated care organizations, or CCOs.

The first quarterly report came out in May. “In summary, by looking at 2011 data from the organizations that preceded CCOs, this first quarterly report shows where we are starting from and where we need to go to get to better health, better care and lower costs,” the report says.

In other words, it's hard to assess how well this is working, yet. There are many promising anecdotes. But it's hard to measure success when you just got started. It's also hard to know what needs to be tweaked, scrapped or pumped up.

Now the board is trying to come up with all sorts of new policies.

There's churn.

Some expand what's already been done. For instance, Kitzhaber asked the board to enhance the government's role in setting rates for health care insurance.

Some new policies try to fix what may be problems. For instance, Kitzhaber wants to mitigate the effect that shifting health care costs have on providers and insurers.

And there could very well be churn and overstretch in the board's exploration of new policies to encourage patient responsibility.

It wants to find ways to encourage people make good choices in diet, exercise and lifestyle and also make good choices about consuming health care.

The board chewed over some dozen ways to do so at its meeting last week.

But the board should take to heart what board member Dr. Carla McKelvey said. She's a pediatrician in private practice in Coos Bay.

She has a patient who is unwilling to give up smoking, because it's that patient's only pleasure. She said she has a family in which the parents and the children have sleep problems. They are homeless.

“This report puts a lot of responsibility on the health care system,” she said, and there are things health care providers cannot solve.

We're not suggesting that the board stop what it's doing or tell the governor it's not going to do what he asked. But there is big pressure for the board and for reformers to demonstrate they are making a difference. Churn can make it look like health reform is happening. It doesn't make it happen.