Editorial: Coordinated Care approach depends on quality benchmarks

Published Dec 27, 2013 at 12:01AM

While news has recently focused on the troubles of the Affordable Care Act and Cover Oregon, another health care reform effort is underway that could dramatically change the way we pay for health care.

Oregon’s experiment with Coordinated Care Organizations, with billions of dollars in support from the federal government, seeks to cut costs and improve health, as detailed recently by Bulletin reporter Lily Raff McCaulou. The experiment is now being applied only to the Oregon Health Plan, Oregon’s version of Medicaid, but planners hope to see it spread to a wider population in the future.

The idea is to change the way we pay for health care, eliminating the incentives for unnecessary care that a fee-for-service model encourages. Many possible approaches are being considered, but the underlying concept is to stop paying for individual services and instead pay providers a lump sum to care for patients.

What protects patients from providers who just don’t order a needed procedure to save money for themselves? The answer, say organizers, is that providers will be judged according to a set of benchmarks that evaluate the quality of care provided.

Those benchmarks look at things like patient satisfaction surveys, the percentage of teens who get well-care visits or how many pregnant women get appropriate prenatal care.

Those who remember the outrages of an earlier generation of reforms that denied needed care through Health Maintenance Organizations in the 1980s are supposed to be reassured.

But as we all know from innumerable other cases, what gets measured is what gets attention. The benchmarks will need to be evaluated to be sure they are effective. Otherwise, we’ll trade one set of perverse incentives for another.