Opinion Editorial from the Oregonian, September 17, 2011
Right now in Oregon, doctors, nurses, state and county employees and 133 volunteers, deployed into four working groups, are hatching a health care revolution.
They know a lot. And this may fall into the category of “Got that covered,” but it’s worth repeating: Prioritize drug treatment.
The public savings involved in treating drug abuse can be enormous. A recent analysis of 703 Oregon Health Plan patients, one year after they started treatment, showed an average drop in their billings for physical ailments of $3,603 per person. The total savings projected was $2.5 million, just for that sample group.
Savings from drug treatment don’t always show up neatly in health care ledgers, though. Drug abuse drains public funds in other ways: in crime, in jail and prison time, in child protective services, in 9-1-1 calls, and, yes, in police shootings. (A dual diagnosis of mental illness and drug abuse is not unusual, but it’s often implicated in lethal police encounters.)
It’s imperative for designers of the health care revamp to widen their lens, not just to focus on holding down hospitalizations and emergency room visits, but on prevention of other social ills, such as child abuse.
It’s doubtful that anyone knows how many Oregonians need drug treatment, since so many people are in denial. But at any given moment, about 800 Oregonians are on waiting lists for residential programs, according to the Oregon Health Authority, with an average wait time of two to four months (with the exception of pregnant women, who are generally placed in less than a week.
The state does not yet collect information on waiting lists for outpatient treatment. But that, along with supportive housing, is the most cost-effective way to address drug-abuse.
It’s a squandered opportunity when any Oregonian seeks out drug treatment, but walks away unable to obtain it. Typically, people have to lose a lot — a job, a driver’s license, a marriage, their kids — to get to the point that they’re motivated to change.
The 133 volunteers at work on the health care redesign have what the state is calling a “triple aim”: reducing per capita costs; improving patients’ health; and improving patients’ subjective experience of their health care. All of this is on a fast track. A first iteration of Oregon’s “coordinated care” changes needs to be ready to roll out in February for the Oregon Legislature to review.
Rarely do we ever get to start over as a society. Rarely do we get to muster our collective wisdom about what did and didn’t work in the past, but this is one of those times. Right now is the perfect moment to shout out a reminder: Escalating drug treatment will save money. It will save families and it will save lives if Oregon can serve addicts at the moment they’re motivated to make a fresh start.
The state’s fresh start on health care demands a new urgency in addressing an old, terribly expensive misery.
I would like to inquire about how many of the 133 volunteers have actually worked in the addiction field. I believe that at least 50% of the volunteers need to be those who actually have hands on experience on what works and what does not work. I also would like to inquire about the weight being given to evidence based practice. While it works for some it has the appearance of being used as a blanket approach. At a recent training I attended in Portland OR it was described as a train that had left the station without the conductor. I have worked in the addiction and domestic violence field for the last 14 years. My experience shows that treating the underlying issues of addiction is really the only thing that gives people the opportunity for long term recovery. I am so excited that this issue is being addressed along with the possibility of the State of Oregon being on board to provide more funding and backing for alcohol and drug treatment as we in the field have known this information about he saving for years. Thank you for your response to my inquiry. Gearl Seal CDS II, CDVC
Hi Gearl.
Here’s the link to the roster.
http://health.oregon.gov/OHA/OHPB/health-reform/docs/workgroups-external-roster-full.pdf
Jim Russell of Mid-Valley probably knows something. He’s been in the arena a long time. Mary Monnat of Lifeworks is very knowledgeable. Jackie Mercer of NARA and Ron Williams of Oregon Action are knowledgeable. I don’t know Tim Hartnett of CODA or Rachel Solotaroff of CCC, but I suspect they know something.
But that’s it. It’s a very political list, and it seems asking 130+ people to create policies which will then be operationalized by other people is, based on extensive past public health policy experience in Oregon, the way to ruin.