OAHHS Hospital Voice Fall/Winter 2019

7 Fall/Winter 2019 driving repeat visits to the ER, which can lead to safety issues for hospital staff. “When you tell patients they can’t have their pain meds, they get mad,” said Fine. That came the same week that Oregon received some sobering news in a state by state assessment of mental health. In the Mental Health America 2020 survey, Oregon ranks 50th out of all states for its high prevalence of mental illness combined with a lower access to care for adults and youth. Oregon is ranked 51st (including the District of Columbia) for just the prevalence of mental illness, and 24th for access to care. Improving the behavioral health care system is a key component of CCO 2.0, the next phase in the effort to transform the state’s Medicaid system, which covers one million Oregonians. And according to Pat Allen, rural health care innovation is at the core. “When we talk about CCO’s, I think, fundamentally, we are talking about rural health,” said Allen. In addition to behavioral health, Allen pointed to maintaining sustainable cost growth, an emphasis on the social determinants of health, and value-based payments as elements that will drive progress toward the Holy Grail of health care: better health outcomes, lower costs, and higher patient satisfaction. Allen said bringing care into the community and addressing the social determinants, as Tveit and other rural hospital leaders are doing, “will get us off the fee-for-service mousewheel.” But Tveit also sounded a word of caution, mostly on the issue of cost, revenue, and resources at his facility. While Allen said it’s important to move beyond the basic goal of “filling beds” at the hospital, Tveit pointed out that walk-in clinics don’t exist in rural areas like Lake County. There’s also a shortage of in-patient beds for behavioral health patients, a problem that every Oregon community faces. “This will impact our margins, and we’ll do it as long as we can,” said Tveit. Rural hospital leaders know there is plenty of uncertainty on the horizon, but they also know to never back down from a challenge. That’s how it works in the wide open spaces of Oregon. You just have to get it done.