Portland doctor says give credit where it's due for drop in ER visits

A Portland doctor has a theory about what lies behind the strides being made in care delivery for Oregon’s Medicaid population.

We reported last week that the Oregon Health Authority issued a report on the state’s 16 Coordinated Care Organizations, highlighting a drop in emergency department visits and rise in primary care visits.

Dr. Evan Saulino, president of the Oregon Academy of Primary Care Physicians, has this diagnosis: The improvements stem not from the CCOs, but from the innovative type of care being delivered at 450 Oregon clinics designated as Patient Centered Primary Care Homes.

“We believe this style of care is the exciting innovation that is driving improved statistics for Oregon’s health care system,” Saulino said in an email. “Over the past three years, nearly half of our primary care clinics have gone to great lengths to reorganize themselves to center around the patient and promote wellness, instead of just supporting patients when they are ill.”

The Patient Centered Primary Care Home program, which goes beyond just the Medicaid population, began in 2009 with state legislation, along with other health reforms.

The idea for the model is based on research from Johns Hopkins University that found that where health care is built on a strong primary care system, the outcomes are better and the costs are lower, Saulino said.

It’s an evidence-based model that promotes better coordination of care, teamwork and understanding the patient population, with an emphasis on prevention and managing chronic conditions. Clinics are much more proactive than in the past, and they check in with patients more and have even added services, such as more nurses and mental health and behavioral professionals.