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The Sunday Oregonian: Bootstrap Effort Puts Health Care In Reach
EUGENE -- Lane County has set out on its own to provide health care for every uninsured resident within its borders, attacking a national problem on a local level. It is one of at least 19 counties in Oregon, 28 in Washington and more than 600 communities nationwide that are building makeshift local health networks for the uninsured --in some cases, producing something like universal care.
"What you are seeing is the beginning of a national movement," said Kristin West, president of Communities Joined in Action, a national organization of communities scrambling to provide health care for everyone.
Soaring drug, hospital and other health care costs have pushed employers to drop health insurance or to offer it at prices employees cannot afford. Forty-six million Americans, including more than 600,000 Oregonians --about one in six --have no health insurance. In Lane County, about one in five lacks insurance.
"We are not going to wait for the feds or the state to do something," said Susan Stearns, director of the ambitious Lane County initiative called the 100 Percent Access Coalition. "We can do something now."
Lane County's initiative and others like it across the country expand health care by building systems that emphasize giving rather than profits. With a core mission of care, they persuade everyone to pitch in: Agencies share resources. Doctors donate a portion of their time. Laboratories provide free tests. Specialists take pro bono referrals. Radiologists offer free X-rays. Drug companies fill free prescriptions. And hundreds of volunteers join work groups, teach classes, help safety-net clinics and provide other services.
"It is just a humane response to a huge problem," said Candice Barr, executive director of the Lane County Medical Society.
100 percent access
United Way formed the Lane County 100 Percent Access Coalition shortly after a survey two years ago showed alarming public concern about health care costs. Survey results became "a rallying cry" for change, Stearns said.
More people were losing health insurance, visiting emergency rooms for their care and racking up debt to hospitals. One in five had no insurance, and a third of the 1,200 households surveyed reported they lacked access to health care at some time in the previous year. The problem hit just about everyone.
More than 100 volunteers --doctors, hospital and insurance company executives, political and community leaders, safety-net health clinic workers and a 30-member steering committee --are working on a plan to reorganize county services so they are more efficient and reach more people --eventually, everybody.
"It is an astonishing example of coordination and cooperation," said Terry Coplin, a coalition volunteer and executive director of the Lane Individual Practice Association, which manages the Oregon Health Plan in the county. "If we can't do it, I don't know who can."
Bottom-up effort
Some see the community project as a Band-Aid until state or national reforms bring deeper, sustainable change. But others see the project and others like it as a bottom-up movement with more promise than top-down federal and state efforts that partisan politics and special interests repeatedly crush.
"By collaborating, we are going to come to a more systemic solution," Stearns said, "and it won't be two or three people cutting a deal in a backroom."
The aim is to help people like Betty Fairlee, 59, of Eugene, who lost her health insurance with a divorce 16 years ago. She went for the next 14 years operating her hair salon, Betty's Hair Corner, without seeing a doctor. One day a decade ago, she visited an urgent-care clinic after a dizzy spell. Her blood pressure had soared.
"(The nurses) wanted me to go to a doctor, but I couldn't afford it," she said.
In recent years, she began feeling lethargic; rashes sometimes broke out on her arms. About two years ago, she found her way to Volunteers in Medicine, a Eugene clinic that opened five years ago to serve the working poor.
Doctors told her she had diabetes. She since has received regular care and monthly classes that have helped her control her disease, regulate her diet and shed 30 pounds.
Had she not found the clinic, chances are she, like many uninsured, would have ended up in a hospital emergency room for more expensive treatment of a more advanced disease.
In the emergency room
On a recent hot afternoon, Sacred Heart Medical Center's emergency room bustled with patients while 17 more waited in the lobby. An intoxicated young woman, a regular, slumped in a wheelchair. A computer showed Dr. Gary Young, emergency medical director, the individual maladies of the moment: a headache, a cat scratch, dizziness, an arm abscess from a dirty needle. Other woes included a stroke, a fractured back, toothache, lower back pain, a rash, chest pain, broken leg, an allergic reaction.
The emergency room sees about 150 patients a day, a third more than it saw a decade ago. And "we're getting older and sicker and more complicated," Young said.
About 15 percent of the patients have no emergency and should be getting primary care elsewhere, he said. But many have no insurance or money to do so.
They are among the people 100 Percent Access wants to steer to doctors or safety-net clinics where they can get primary care at lower costs and ease pressure on emergency rooms.
Reorganizing to serve more Lane County is trying to reorganize its way to a solution, to offer every resident primary, mental health and specialty care --essentially, universal health care.
"We're ultimately talking about people having the right care at the right place at the right time," said Ken Provencher, president and chief executive officer of PacificSource Health Plans, a nonprofit health service contractor and chairman of the 100 Percent coalition.
The theory is, about 30 percent of every health care dollar spent goes to waste because of a fragmented, inefficient health care system, said West, the Communities Joined in Action president. If a county can recover even 10 percent of that waste, it can extend health care to all of the uninsured, she said.
West also is executive director of CHOICE Regional Health Network, a nonprofit health collaborative involving five Washington counties from Tacoma to the coast. She has helped more than 500 such collaboratives, including Lane County, get started across the nation.
Few are moving as aggressively as Lane County, which is attacking the uninsured problem on multiple levels, she said.
Critical goals
The 100 Percent Access Coalition won a $1 million federal grant and hired Stearns to direct the project and set up work teams around eight critical activities: enrolling uninsured people who qualify for the Oregon Health Plan or other programs; finding affordable drugs; helping people manage chronic diseases, such as high blood pressure or diabetes; finding a medical home for everyone; finding insurance for low-wage workers; organizing donated care; developing prevention and wellness services for the uninsured; and continually measuring overall effectiveness.
The coalition offers English and Spanish classes to the uninsured in rural or low-income areas on how to manage chronic diseases, a curriculum developed by Stanford University.
This fall, the coalition expects to reach out to the uninsured to see whether it can enroll them in the Oregon Health Plan or connect them with a safety-net clinic or one of a number of doctors who provide charity care. Some radiologists and laboratories have agreed to provide tests, and a work group is developing a plan to consolidate sources of free or low-cost prescription drugs.
Hurdles to overcome
Still, a big obstacle is finding enough doctors to serve everyone who needs care. Lane County, with a population of 336,085, has 665 doctors --roughly one for every 500 residents and a lower ratio of primary-care doctors than that of many Oregon counties. Organizers would like more efficiency, possibly finding circumstances in which doctors could provide a level of routine care to groups of patients. "A single physician with a single patient may not be a sustainable model," Stearns said.
Another idea is to let physician assistants, nurse practitioners and other nurses take over more routine care.
The county also expects to tap its safety-net clinics for more care and has produced a quick reference guide summarizing their services to streamline referrals.
White Bird Clinic has served the indigent and poor for decades, and two other clinics have opened in the past five years.
Volunteers in Medicine, the community-supported clinic where Betty Fairlee found care, opened in 2001 to care for the working poor. More than 200 patients a day pass through the clinic, staffed by 55 to 60 volunteer doctors and other providers. Many patients have not seen a doctor in five years, said Susan Whitehouse, the nonprofit's executive director.
Two years ago, RiverStone Clinic opened in Springfield with two doctors and four nurse practitioners to serve Oregon Health Plan patients and the uninsured. In addition, the federally supported clinic operates a satellite clinic for homeless youths in Eugene and a health center at Springfield High that also serves adults. Collectively called Community Health Centers of Lane County, the clinics provide health and dental care for 8,000 low-income people, including 1,200 homeless youths.
Plans are in the works to open other centers in more schools and in cities such as Cottage Grove, said Steve Manela, the centers' program director. The clinics, he said, are "positioned to be a key player in expanding access and care."
Elsewhere in Oregon
Other Oregon communities also are searching for ways to offer more people health care.
Northeast Oregon Network, a coalition of health and social service groups in Baker, Union and Wallowa counties, is tackling the distance barrier by sending a Lions Club health and vision screening van through the region and busing low-income people needing teeth repair to a dental school at Eastern Oregon University in La Grande.
Central Oregon Health Collaborative recently formed to expand access to health care in Crook, Deschutes and Jefferson counties.
The boards and public health directors of Washington, Clackamas and Multnomah counties created the Tri-County Health Care Safety Net Enterprise, with the goal of providing health care for all uninsured people. The two-year-old network is focused on streamlining emergency care, finding doctors and specialists willing to donate services, and providing affordable drugs for the uninsured.
These efforts are not the radical reform needed to bring change to the health care system, but they will help, said Maryna Thompson, interim director of the tri-county enterprise. And, she added, they allow health care providers to return to their core mission of healing after losing "bits and pieces of themselves" in an increasingly expensive, fragmented system.
No one in Lane County is sure where the 100 Percent Access Coalition will take them. But organizers are sure they can't wait for someone else, said Laura Brennan, a participant of PacificSource Health Plans.
"These are our neighbors and friends," she said. "We've got to do something."
Bill Graves: 503-221-8549
billgraves@news.oregonian.com
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