The magazine of the UW School of Public Health

Taking the Lead: Central Oregon Regional Health Council

Muriel DeLaVergne-Brown

In organizations, real power and energy is generated through relationships.  The pattern of relationships and the capacities to form them are more important than task, functions, roles, and positions. 

  — Margaret Wheatley, EdD

Extraordinary changes are underway in central Oregon. These changes are driven by the Patient Protection and Affordable Care Act (PPACA) and a shared desire to unify public and private health sectors to improve the public’s health.

Building a Foundation

Even before passage of PPACA, work was started in Oregon to coordinate across health-related organizations and agencies. In 2009, the Oregon State Legislature created the opportunity for regions to band together in pursuit of a single point of fiscal accountability for health plans and programs serving low income populations. 

In response, three central Oregon counties mobilized. With participants from Deschutes, Crook, and Jefferson counties, an advisory council formed, led by staff from St. Charles Health System. The advisory council included local public health and mental health directors, Medicaid payers, safety-net clinics, and the Central Oregon Independent Practice Association. 

Initially, the advisory council formed to address coordination of behavioral health and primary care, but as health care reform developed, the group’s scope expanded, and implemented pilot programs through St. Charles Health System, Mosaic Medical, and various partners. Examples of these pilots included emergency room diversion, patient-centered medical homes, and a community health worker program.

In 2009, partners formed a transitional board called the Central Oregon Health Authority that included a county commissioner from each of the three counties, Pacific Source (a managed care organization), St. Charles Health System, and various medical providers to oversee the development of the work and create a framework for health care reform in central Oregon. The advisory council supported the work of the transitional board and the pilot projects.

Central Oregon Health Council

In July 2011, Oregon Governor John Kitzhaber signed SB204 that created the Central Oregon Health Council (COHC), changing the transitional board into a permanent entity. The COHC is a unique, collaborative initiative made up of central Oregon stakeholders. COHC oversees, evaluates, and guides the planning, coordination, and development of population health initiatives including community health assessment, regional health improvement planning, and development of the Coordinated Care Organization in central Oregon.

COHC will carry out a number of strategic objectives over the next four years. The COHC is the oversight body for all regional health planning and policy. It is not a service provider. Rather, its purpose is to serve as the home for a regional health improvement plan. This plan will inform and guide the development and implementation of public and private health care services throughout central Oregon.

In February of 2012, the Oregon Legislature approved SB1580, the Coordinated Care Organization Implementation Proposal. Coordinated Care Organizations (CCOs) in Oregon are local health entities that deliver health care to Medicaid patients and focus on community-level accountability, elimination of health disparities, and integrated care. CCOs are governed by community partnerships and are meant to be equivalent to the accountable care organizations identified in PPACA. These partnerships are among care providers, community members, and health systems stakeholders. CCO governance includes county commissioners who represent local public health. CCOs must have community advisory councils in place to ensure that the health care needs of consumers and communities are being addressed. In central Oregon, COHC will serve in the role of community advisory council for the CCOs in central Oregon.

In these efforts, local public health has had several important roles to play.

First Role: Community Assessment

Local public health has the ability to bring partners together and lead the community assessment process. In central Oregon, local public health, working within the COHC structure, led a year-long process that gathered data for the region, identified gaps in services, and proposed a structure for the regional health improvement plan. The St. Charles Health System was a key partner in this process and provided funding, technical expertise, and staff support. During this experience, partners evaluated various community assessment tools and chose the Health Community Institute tool. The community assessment process helped to

  • promote development of the community health assessment partnership;
  • build technical skills of community partners;
  • use data for program and policy decisions in the region; and
  • engage community residents in assessment, local planning, and evaluation.


While the assessment process was challenged by the number of time-intensive meetings it required with multiple stakeholders, the COHC reached consensus and prepared to move forward with the creation of a regional health improvement plan.

Second Role: Regional Health Improvement Plan

The second role for local public health has been to assist the COHC in the planning and development of the regional health improvement plan based on the community assessment process. For this plan, input from the St. Charles Health System, private providers, managed care, and citizens has been critical. The regional health plan was guided by the following goals:

  • Equity and access
  • Health improvement
  • Care and service delivery improvement
  • Cost reduction and cost effectiveness
  • Health integration and collaboration
  • Excellence
  • Organizational improvement through regional efforts
  • Health policy


These goals are consistent with the Institute of Healthcare Improvement’s triple aim of improved population health, enhanced patient experience of care, and controlled cost. The plan’s vision is to transform the health of the region’s residents through community alignment in all areas of health care including local public health.

Also, the development of a community health assessment and a regional health improvement plan are prerequisites for national public health accreditation. As health care reform moves forward in Oregon so does the opportunity to improve public health.

Regional Coordination of Public Health Programs

Through COHC partnerships, coordination of public health services in central Oregon is improving. As a result, the counties combine efforts for Nurse Family Partnership, chronic disease programming, teen pregnancy prevention, and public health accreditation. One of the many positive lessons learned is how to engage county commissioners whose leadership will be essential to health care reform. As supporters of public health, they are well positioned to promote community-based prevention efforts in their counties.

This work is exciting and has given hope in the region for new initiatives to improve health. The partnerships formed in central Oregon capitalize on shared values to form a robust network dedicated to organizing and sustaining efforts to improve population health. With public-private partnerships, local public health can engage the private sector and community representatives in building a healthier future.

Author

Muriel DeLaVergne-Brown, RN, MPHc, is Public Health Director, Crook County, Oregon.

Resources

  1. Berwick DM, Nolan TW, Whittington J. The triple aim: Care, health, and cost. Health Affairs 2008; 27(3):759-69.
  2. Institute of Medicine Committee for the Study of the Future of Public Health: The Future of Public Health. Washington, DC: National Academy Press, 1998.