On July 22, I attended a conference held in Portland by CareOregon. Presenters were Sven-Olof Karlsson, CEO, and Goran Henriks, Chief of Learning and Innovation, from the County Council of Jonkoping, Sweden. The title of their talk was "Whole System Transformation: Intentional Design".
First, a little history of CareOregon: CareOregon is a non-profit Medicaid managed care health plan (MCO) serving Oregonians eligible for the Oregon Health Plan. Created in 1993, it opened as a health plan in 1994 and obtained legal non-profit status in 1997. Although there are over a dozen other managed care organizations in the state serving the same role for OHP members, those of us in Portland are most familiar with CareOregon; it is the largest Medicaid managed care plan, and approximately 80% of its members live in the Portland area.
CareOregon has been playing a leading role in health care reform efforts in Oregon. Its medical director, Dr. David Labby, presented information to the OHFB Delivery Committee several months ago about the patient-centered medical home model used successfully by the South Central Foundation of Alaska. The Delivery Committee used this model as the basis for development of their Integrated Health Home care delivery concept.
Back to the conference: Sweden has the elements in place that one could assume would ensure low health care costs and high quality: universal coverage that is administered at the local county level, a tax system that supports health care funding (the Swedes pay approximately 50 % of their incomes in taxes), and a strong cultural value for social support systems. The presenters, who are health administrators for the southern Sweden county of Jonkoping, were not pleased with the health outcomes in their local district. The experience of the individual patient was fragmented, and measures of certain health problems, like childhood obesity rates, were climbing.
To learn how to incorporate continuous quality improvements and lower costs, they turned to - guess where - the United States! Specifically, they used the microsystems concept of improvement in health care developed by researchers at Dartmouth, (see the PDF, "Microsystems in Health Care: The Essential Building Blocks of High Performing Systems" for more info), and to measure outcomes improvement they used the Triple Aim developed by the Institute for Healthcare Improvement, (The current newsletter for CareOregon has an article about the Triple Aim.)
About a decade ago, they used this comprehensive approach to begin transforming their health care system at the county level. In keeping with the microsystems concept, quality improvements are first addressed through "projects" that are benchmarked and then adopted by the whole system if successful. All participants in the project address cost, and a fundamental assumption is that higher quality can also mean lower costs. Three of the successful projects mentioned during the conference were the asthma team for pediatrics, combating childhood obesity, and combating dental caries. Particularly impressive is the fact that in Jonkoping the childhood obesity rates are actually now decreasing!
There are many lessons to be learned by the example of Jonkoping, but as CareOregon's Dr. Labby concluded at the end of the conference, perhaps the biggest lesson for us to learn is that "Intentionality is the key to system transformation."
