Oregon's CCO Transformation

In Oregon, healthcare reform will be centered around new Coordinated Care Organizations (CCO).  Much of this is still barely understood by providers, but in fact the implementation will begin this year.  To get a general overview of what the CCOs will encompass and their role in Medicaid, click here for a presentation put together by the Oregon Association of Hospitals and Healthcare Systems.

Falafel and the Triple Aim

As I am writing this, I’ve just returned from a visit to Portland. I have a favorite restaurant there called Nicholas’. Located near the Convention Center, it serves Mediterranean dishes: Lebanese and Greek. It is one of those many hole-in-the-wall places that has built a huge loyal following over the years. On most any evening there will be a cluster of people outside—regardless of the weather—waiting for a coveted table to become available. The staff is somewhat surly and they only accept cash, but the business has succeeded to the point where they recently opened another restaurant in the Northeast district of Portland.

We decided to try the new restaurant. I’ve always believed that expansion is the test of a small business, especially a restaurant.  With expansion, often the service or food quality fails to meet the standard set by the original location.  I’ve seen many instances where adding another store will actually cause both to fail. Not so in this case. Our wait staff was actually a bit less surly, the food was as excellent as ever, and they appeared to be accepting credit cards. I saw many customers who seemed to be of Middle Eastern descent, so the local ethnic acceptance of the restaurant remains strong in the new location. I felt that the money we paid for dinner was well spent.

I believe they’ve succeeded in their expansion. And I could relate their success to our own goals at Asante. Since healthcare is entering the era of the Triple Aim (improved outcomes, enhanced patient experiences and reduced costs) we might be able to glean some lessons from this small business.

What we are measuring is reliability, consistency, and efficiency. On the evening of my visit, Nicholas’ achieved that trifecta of value: My expectations regarding food and service quality were either met or exceeded, and the price had not gone up. Can we say the same regarding the expectations of our customers?

At Asante, we do pretty well at efficiency. Doing well at reliability would mean that we always achieve the desired result, and consistency means that we use standard methods to achieve those results. (After all, how can we improve a process that is inconsistent?) Right now, as an organization, we have room to improve in those areas of consistency and reliability. And, as you should know, unless we are top-tier in all areas of measurement a payment penalty will be imposed by Medicare in the very near future. Imagine the challenges to us as an organization if we are still trying to improve ourselves when we are experiencing additional reductions in payments.

We will be striving to standardize and improve our processes, our patient experience and our patient care protocols in the coming months and years. This standardization sometimes goes against the grain of healthcare professionals, but the organizations who are exceeding the average benchmarks have already proven that this is the pathway to improve performance.

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Fourth of July

Our next important national holiday is, of course, the Fourth of July. We’ll see lots of flags, picnics, parades and alcohol consumption (with a likely spike of business in our ED). We tend to think of the day in terms of whether or not we have to work on the holiday.

These photos were taken about half way between Cuba and Florida last March when I was on vacation. The captain of our cruise ship spotted this tiny boat, loaded with 18 souls and what appeared to be a very underpowered outboard motor, heading north from Cuba. It had no shade, and who knows what provisions. I doubt there was more than 12 inches between the waterline and the gunwale. When the boat was spotted, the seas were very calm but I have no doubt that if any significant swell or wind appeared the boat would have been swamped and all aboard would have perished.

Hundreds of passengers on the ship watched from the rail as our Captain stood by waiting for a Coast Guard cutter to arrive about an hour after he’d spotted the refugees. The cruise ship passengers represented those privileged people from all over the world who, a few hours before, were collectively complaining about the freshness of the unlimited buffets or quality of the coffee, or whether the spa or casino on our ship was any good. The contrast between us and those on the little boat could not have been greater.

It made me appreciate what the holiday really represents: A special freedom that has been fought for and that is still being perfected in this country. And a freedom so coveted—in spite of its imperfections—that these 18 people took a long-shot risk of their lives to achieve it. Thanks to those who have worked to preserve this country’s freedoms.

Our own Geneva Craig is one of our freedom fighters: She participated alongside of Rev. Martin Luther King Jr. in many of the civil rights marches and demonstrations during the 1960’s. She was there at Bloody Sunday in Selma. The courage that it took to step up and peacefully absorb the violence delivered to the marchers is another marker for the meaning and value of our freedom. Thank you, Geneva.

Several of our staff have also either served directly in the Armed Forces, or kept the faith while their loved ones served. Thank you all, too.

I’ll be pausing a little longer this year to reflect on what this day means. I hope that you do, too. Be safe, enjoy.