SALEM, Ore. - More than 340,000 new people have joined the Oregon Health Plan since January, and a new report says it's a system that has shown major improvement in the past year.

The state tracked what coordinated care organizations (CCOs) are doing for Oregon Health Plan or Medicaid patients. It found that the number of outpatient primary-care visits increased by 11 percent in 2013, an indication that more people are getting care sooner and not at emergency rooms.

Mimi Haley, regional executive at Columbia Pacific CCO, said that means it's likely to save the state money in the long term.

"You can drive down inappropriate emergency department utilization by making sure that people are getting connected with primary-care services," she said, "that those primary-care practices that are medical homes are doing the outreach to say, 'Hey, we haven't seen you for a while, and we really need to bring you in for your mammogram.' "

Haley said CCOs' current challenge is to keep up the higher standards while serving a lot more patients this year. Her CCO grew from 15,000 members to more than 24,000 when the Affordable Care Act made more people eligible for the Oregon Health Plan.

The state report said more babies are being screened early for health problems, and there are fewer hospitalizations for chronic conditions among Oregon Health Plan members than in previous years.

Dr. Jim Rickards, health strategy officer for Yamhill Community Care Organization, said it's partly the result of collaboration between different types of health-care providers, and because patients are part of CCO committees and workgroups.

"Before the CCOs really took off, there wasn't really a lot of dialogue between those parties, or even with the members who were receiving care. We weren't really getting their feedback," he said. "But now, with these CCOs, we have a platform for everybody to communicate, form relationships and start working together."

The Oregon Health Authority tied improvements in 17 areas to bonuses for CCOs' performance, which they will now receive and use to make further improvements. It is Medicaid money originally intended for the CCOs' budgets that was held back as an incentive for them to meet or exceed their metrics.

The report is online at oregon.gov.


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According to experts in the field, the system of developing new antibiotics is broken and doctors are running out of ways to treat deadly infections.

Lawmakers have proposed the PASTEUR Act to fix the pipeline. New antibiotics are critical but they must be used sparingly, which means private drug companies cannot recoup their investment.

David Hyun, director of the Antibiotic Resistance Project at the Pew Charitable Trusts, said the bill would establish a subscription model to fund research for certain drugs approved by the Food and Drug Administration.

"It delinks their revenue from the volume of sales and provides an up-front payment to the companies purely based on the value of the public-health value of the new antibiotic," Hyun explained.

The Centers for Disease Control and Prevention said patients in the U.S. contract 2.8 million antibiotic-resistant infections each year and more than 35,000 of them die. Experts estimate the U.S. spends $4.6 billion a year to treat infections caused by drug-resistant germs.

Dr. Sarah Doernberg, an infectious disease specialist and professor of medicine at the University of California-San Francisco, said the ability to treat infection dictates the safety of all kinds of medical procedures from giving birth to having surgery.

"We are able to operate ICUs and transplantation and give chemotherapy agent," Doernberg noted. "All of these things that we do that are very invasive and come with risks of infection, and we need to be able to treat the infections in order to be able to provide modern health care."

Despite bipartisan support, a similar bill failed to pass in 2021. Senate lawmakers reintroduced the PASTEUR Act in 2023 with reduced funding but it remains stalled in committee.

Support for this reporting was provided by The Pew Charitable Trusts.

Routine blood draws during a doctor's visit can reveal disorders or diseases and as the number of patient caseloads inches upward as the population ages, the Hoosier State is facing a shortage of hematologists, the doctors who treat abnormal blood conditions.

It means patients may experience delayed access to treatment.

Dr. Mukul Singal, hematologist at the Indiana Hemophilia and Thrombosis Center in Indianapolis, believes hematologists need to be trained to break the cycle which draws many to only the study of hematology oncology, or blood cancer, after their initial hematology training.

"More and more medical students, and even more than medical students, internal medicine residents, need to be exposed to hematology clinics, to inpatient hematology," Singal contended. "Once they go there and they get exposure to that, it is something that draws people in."

Singal pointed out one way to meet the need is to increase the number of mentors. He added the American Society for Hematology has started 10 fellowship programs to train 50 hematologists over the next 10 years. Four years of medical school, three years of residency, and two to four years of fellowship for adult, pediatric hematology/oncology or pathology training are required to become a hematologist.

Singal argued bureaucrats and decision-makers should allocate more funding for mentoring as a path to increasing the number of hematologists per patient. Doing so would allow more time for patient-doctor engagement during appointments. Singul stressed the average physician spends just 15 to 20 minutes per patient.

"That sort of leeway has to be available to physicians, so they don't have the financial disincentive when they talk to patients, they spend time with patients," Singal emphasized. "That is something that is a little beyond me, but that needs to change as well."

Singal added hematology patients can expect 30 to 60 minutes on average for new patient appointments and longer to ask questions if a patient's condition is complex or if additional exams are needed right away. The Indiana Hemophilia and Thrombosis Center is the only federally recognized hemophilia treatment center in Indiana.

For 100 years, the American Heart Association has been dedicated to improving heart health and raising awareness about cardiovascular disease, yet a Harris Poll in 2023 revealed more than half of Americans still do not recognize heart disease as the nation's leading cause of death.

The ongoing challenge underscores the importance of cardiac rehabilitation programs, which help patients recover from heart-related events and learn preventive health practices.

Murphy, 100, a notable participant, recovered from a silent heart attack through cardiac rehabilitation at Novant Health, serving as an example of the effectiveness of programs like this in helping people reclaim their health.

"I'm trying to maintain my strength and that's why I continue coming here," Murphy explained.

American Heart Association data show strokes and heart diseases together account for more U.S. deaths than cancer and chronic respiratory diseases combined.

Jan Wagoner, director of cardiopulmonary rehabilitation for Novant Health, said cardiac rehabilitation offers patients a vital pathway to recovery by helping them regain a sense of control and wellness. She pointed out patients like Murphy get medically supervised exercise, nutritional guidance and a supportive community.

"He was one of the few blessed patients who had been active enough in his life and had good genetics that his heart had created its own bypasses," Wagoner noted. "We call that collateral circulation. And so he was in rehab, gaining strength, gaining knowledge, regaining that sense of control over his life, feeling like he was thriving again."

She stressed cardiac disease is increasingly affecting younger adults and the shifting demographic illustrates how lifestyle choices can have significant consequences later in life. Wagoner emphasized adopting healthy habits including regular exercise and a balanced diet can make a substantial difference in heart health over time and reduce the risk of heart-related events.

"This is a disease that doesn't choose an age anymore," Wagoner observed. "It used to be that people were in their 50s, 60s, 70s and 80s, and then it's now in their 30s and 40s and we see it all across."

The American Heart Association's Life's Essential 8 guidelines highlight simple steps for better heart health, focusing on two areas: healthy habits like eating well, staying active, quitting tobacco, and getting good sleep; and managing key health factors such as weight, cholesterol, blood sugar and blood pressure.


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