Forum addresses Multnomah County's role in early childhood programs and healthcare as changes take shape in Oregon

March 11, 2013

More than 75 people attended a citizen involvement meeting on March 6 to learn Multnomah County’s role in the state’s changes in two huge areas -- how it serves young children and how it delivers health care to people on the Oregon Health Plan.

Statewide almost $1 billion is spent on children. Jada Rupley, the state’s early learning system’s director, said Gov. John Kitzhaber has appointed an 18-member council to look at how well current practices prepare children for kindergarten. A child who is ready for school and can read in third grade, has been shown to be more successful in middle school and likely to graduate high school.

“That doesn’t start the summer before kindergarten,’’ Rupley said. “It starts when children are born.’’

The governor has directed an additional $32 million to early learning, Rupley said. Oregon also won a coveted $20 million federal grant to ensure all children are also ready to read in first grade and reading at third grade level in third grade. The idea is that they learn to read by third grade so they read to learn during the rest of their school years, she said.

“If we don’t get it right in these early years, it costs so much more later on,” Rupley said.

Beginning in September, all children in Oregon will take a kindergarten assessment in their first six weeks of school. Currently, children are not assessed until second grade.

“It’s not to exclude children from school, it’s a snapshot of what kids know and what they need to know,’’ Rupley said. The state will then work to identify what families need; link them to the services; and identify what is needed to hold the systems accountable.

Multnomah County has key pieces of the early learning work, says Joanne Fuller, chief operating officer, including the Multnomah County Library and the SUN (Schools Uniting Neighborhoods) Service System.

Health care and health care coverage are also undergoing major changes.

Lillian Shirley, director of the Multnomah County Health Department, described how health reform is affecting county residents. Shirley, who is also the vice chair of the Oregon Health Policy Board overseeing health reform, said families, businesses and the state can no longer afford the current system.

For example, because a person’s doctor and dentist don’t work together, important information is missed.

Nationwide, too many babies are born prematurely. “We recently learned through research that one of main reasons women go into labor is because moms have dental infections. So this isn’t just about teeth, it’s about the future of children,” Shirley said. “We’re getting smart enough to see it’s all connected.”

Oregon’s answer to the cost and lack of coordination has been to create coordinated care organizations, or regional hubs that create a better network of care around patients. The changes will transform the payment system, coordination around patients and community collaboration.

As of Jan. 31, 2013, all 109,517 Multnomah County residents who are on the Oregon Health Plan have been enrolled in the region’s two coordinated care organizations: Family Care and Health Share of Oregon.

Shirley said Multnomah County will continue to offer primary care, dental and behavioral health services. The county serves more than 70,000 people a year at more than 33 award-winning clinics and will retain the same providers. The county also remains the local health and mental health authority.

Janet Meyer, chief executive officer of Health Share, said the system Oregon is building is a model. “The entire nation is watching us,” Meyer said. “And we believe the model we’re building will achieve the health reform our nation needs.”

She said if food prices had risen like health care, a dozen eggs would cost $80 and a dozen oranges would be $107.

“Health care has been gobbling up our resources,’’ Meyer said.

A CCO is a network of all health care providers who have agreed to work together today for people on Medicaid. It has one budget to provide all physical, behavioral and dental health.

The new model also relies on non-traditional health workers, coordinates physical, mental, addictions and dental care and is measured by outcomes that make the system accountable and more transparent.

“We’re not just paying for visits, we’re paying for the outcomes of visits,” Meyer said.

Health Share is run by a partnership of hospitals, health plans and Multnomah, Washington and Clackamas counties, and is accountable to a community advisory board.

Steve Weiss, chairman of the Health Share advisory counsel, said he receives health care through the Oregon Health Plan and that he is optimistic the changes will result in better health for all, a better patient experience and a more affordable cost.

The final change in health care underway is an insurance exchange or marketplace created by the Affordable Care Act.

Samantha Shepherd said Cover Oregon was created in 2011 as a public corporation like Port of Portland. Cover Oregon’s role is to build one front door for health coverage for individuals and businesses with fewer than 50 workers. Beginning Oct. 1, Oregonians can go online to the Cover Oregon website, enter their financial and family information and find insurance plans they can compare and purchase.

They will also find if they are eligible for tax credits that can cover up to all the cost of that insurance. The insurance coverage would then begin on Jan. 1, 2014.

For more information:

Watch video from the forum, "A Healthier Future for Multnomah County."

Let the county know what you think about new initiatives for healthcare and early childhoold programs by taking a survey available in English or Spanish.