Health Care--by Community.

• Author: Rickards, Jim
• Position: MEDICINE & HEALTH

THE ISSUES WE FACE in Yamhill County, Ore., plus or minus, are the issues that all communities across the country face every day. Health-care spending is on the rise. Patients and health-care providers alike are frustrated because they are getting unsatisfactory results. Insurance companies are increasing their sway. There is a lack of communication within health-care provider networks--and, thanks to ObamaCare, we all want and need a better system.

Oregon has decided to address these issues with its new Coordinated Care Model, which is delivered through organizations called coordinated care organizations (CCOs). Thus far, Yamhill has been able to improve care, lower costs, develop relationships among providers, and give patients a true voice in their health-care system.

Health care, much like politics, is local. What is occurring in Yamhill would require some adaptation if it were to be configured to the specific needs of other communities. At the same time, what is happening here could work just about anywhere. A man slips on the stairs, falls, and breaks his wrist. Regardless of where in the U.S. this occurs, the key issue is the same: do you only treat the wrist, or do you look at the big picture?

Our approach allows us to look at the big picture--to consider why the man broke his wrist in the first place, instead of just treating it. Maybe he lived in a dilapidated house with the electricity cut off and it was cold and dark. Maybe he had PTSD or depression. Taking care of him is a lot more than just setting the wrist. It is about recognizing and treating patients from a big-picture perspective.

Urban areas have unique challenges, given the larger number of people that are packed into a smaller geographic area--and yet, Oregon has urban CCOs that are doing similar work to Yamhill County. Also, in larger cities, like Chicago, D]., one idea is that each ward could be its own CCO. It just depends on how one defines community and whether one can put the right people into leadership positions. Can it work anywhere? It certainly can improve things anywhere.

If you are concerned that the CCO concept might not function properly in your community because a meaningful percentage of your patients are of cultural or ethnic diversity, note that, in Yamhill County, nearly 16% of the population is Hispanic. Hence, we consciously work to make our services bilingual and inclusive. Things do not have to be a one-size-fits-all variety.

So, how does one...