"Blue States" and Health Policy

            Maryland’s former governor (also 2016 Democratic Presidential candidate) Martin O’Malley joined Oregon’s former Governor John Kitzhaber in a discussion of how their two states’ experiences can inform efforts to provide better health care to more people for less money. The discussion took place on Friday, January 6, before an overflowing crowd at the Multnomah Athletic Club in Portland.  Introduced by Dr. Sam Metz, the two governors applauded the movement in Oregon toward universal health care, for which Dr. Metz is a key advocate, through his leadership in Physicians for a National Health Program-Oregon.

           The governors agreed that we solve nothing by continuing to divide ourselves into “red” and “blue” states. 

            Oregon uses Coordinated Care Organizations to provide Medicaid, and Maryland, an all-payer hospital system. Under the leadership of Governor O’Malley, the state of Maryland realized unprecedented cost savings through its “all-payer model,” described here and, more recently, here.

            The system in Maryland rewards hospitals for patient wellness, and reimburses hospitals based on positive outcomes rather than illness, turning the old market model on its head. The market model rewards hospitals for illness, because every bed full equals profit—like in a hotel. The Maryland model turned this around, instead incentivizing hospitals for empty beds and closed wards.

Through its unique rate-setting process, the 46 acute care hospitals across Maryland saw patient volume decline and income increase, through redeploying resources to improve patient wellness. In the all-payer model’s first year, according to O’Malley, actual savings to Medicare alone totaled $165 million.

            The all-payer system works because it incentivizes wellness and is data-driven through the state’s innovative health information exchange, known as CRISP (Chesapeake Regional Information System for Patients). In addition, CRISP benefits public health. Through data shared across the state, Maryland can now map disease “hotspots” that enhance rapid, targeted, cost-effective responses to public health issues, like potential epidemics.  

            Speaking of the Affordable Care Act, Governor Kitzhaber reminded the audience that even before the ACA, insurance premiums in Oregon were increasing by double digit percentages. Yet, keeping what is good about the ACA is important; in Oregon alone, nearly 400,000 more Oregonians now have health insurance than before the ACA. What must happen now is a drastic reduction in health care costs—something that the ACA never addressed, and that the Maryland model does.

            Looking toward the future, both leaders called for bipartisan cooperation to accomplish the needed health care cost reductions. We must move beyond opposition for the sake of opposition toward actions that are based on the principle of upholding the dignity of every person.