Winter Spring 2018

12 » A magazine for and about Oregon Community Hospitals. Wobbly federal and state funding mech- anisms definitely stirred up a “pot full of uncertainty” for Oregon’s health sys- tems in 2017, says Peter Hofstetter, CEO of Willamette Valley Medical Center, Capella Healthcare. Measure 101 affirms the bipartisan fund- ing package hammered out last legislative session, but Oregon’s health care funding woes are chronic, and their effects ripple across Oregon’s communities, themselves contending with broad shifts, observes ErikThorsen, CEO of Astoria’s Columbia Memorial Hospital. As hospitals hustle to manage dollars, they must also anticipate and respond to changing patient demographics and health needs, he says, “Trying to balance all of this while reducing costs is a sig- nificant challenge.” Pushing the care paradigm forward has required hospital leaders to embrace dis- ruption and innovation as two sides of one coin, says Dave Underriner, Chief Executive, Oregon Region, Providence Health & Services. “People aren’t just standing still; they’re looking and saying, ‘Can we create different ways to serve that aremore efficient andmore effective? Can we create better access at a lower cost?’” ‘How can we make it easy?’ Late 2017 was a banner season for big moves, including the CVS-Aetna merger and Optum’s purchase of DaVita Medical Group, and the market’s rumbling afresh this year, thanks to Amazon, Berkshire Hathaway, and JP Morgan Chase’s enig- matic January announcement of the cre- ation of an “independent company” aimed at lowering U.S. health care costs. In Oregon, consolidation by way of ver- tical integration is trending. In 2015, Legacy Health acquired a fifty-percent stake in PacificSource Health Plans, while Providence Health & Services now admin- isters or provides health care coverage to over 375,000 members through its Prov- idence Health Plan. Meanwhile, insur- ers themselves are increasingly favor- ing narrower care networks of preferred providers. In 2018, ever-higher deductibles and pre- miums remain a key concern, both for consumers and the hospitals who must collect payment. Providence is tackling those rising costs by re-examining the social determinants of health, according to Underriner. Study things like cyclical poverty, job access, and the adequacy of patient support systems, he says, and patterns emerge, which hospitals can ref- erence while crafting or retooling their approaches: “This is an important time in health care. We have the opportunity because of the positions of our organiza- tions in the communities we’re in, locally, statewide, and federally, to be a voice and to be actively engaged in helping to change and move the system forward.” The ascendancy of ambulatory surgical centers, independent clinics like Zoom- Care, and retail clinics at stores like Wal- greens and Walmart may well offer con- sumers lower costs and the opportunity to shop around, but the models pres- ent a predicament for hospitals, notes Hofstetter. If consumers increasingly rely on independent clinics for common, profitable procedures traditionally per- formed by hospitals, those hospitals might struggle to cover the significant overhead of patient care. At Willamette Valley, anticipating these changes has meant experimenting with new care delivery mechanisms, including in-home and virtual visit options, plus building stronger relationships within the community. That work requires reconsidering some pretty foundational questions, admits Hofstetter. “What do you want your system and your state to look like, and what part do you want a hospital to play? How can we provide a convenient service in these big old buildings? How can we make it easy?” continued 