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Cascade Health Alliance CEO

Tayo Akins, Cascade Health Alliance CEO, stands outside the coordinated care organization’s (CCO) offices along Daggett Avenue Monday, May 14. The CCO is preparing for several framework updates set to help with its community health-related goals between 2020 and 2025.

To many, obtaining steady health care can be more than daunting. This is often where coordinated care organizations, or CCOs, work to bridge the gap.

Cascade Health Alliance, which has 17,000 members in the Klamath Basin, is gearing up for the Oregon Health Authority’s “CCO 2.0” phase, which is a framework that could help shift how 15 local care providers assist their members between 2020 and 2025.

Several of the current metrics involve focus around social determinants of healthcare, which factor in concepts such as education, social needs, the economy and environmental conditions.

“If you take care of the social issues of our members, it drives health care outcome over time,” said Tayo Akins, CEO at CHA.

Current deadlines for CHA to submit their own updates for CCO 2.0 plans are slated for January 2019.

Several rural areas across Oregon have dealt with the issue of fewer primary care doctors available as the number of patients in need rises.

Though rural and frontier areas are already struggling with retaining nurses, the entire state could experience more shortages by 2025, according to 2016 reports from Oregon Health Science University’s rural listening task force.

There were 548 primary care providers spread across 1.3 million rural Oregon residents in 2015, according to the report. In comparison, there were 1,619 doctors for 2.5 million people in urban areas.

Doctor shortages have been nothing new for the Klamath Basin, either: Data from 2014 shows Klamath County had 84 providers per 100,000 population, according to figures from the Healthy Klamath Initiative.

Examining Klamath

Dr. Grant Niskanen, president for medical affairs at Sky Lakes Medical Center, reported in December 2017 that they have made a concerted effort to hire more advanced practice practitioners, or APPs, and physician assistants to increase their primary care.

At that time, the hospital had plans to hire four APPs between then and now. Niskanen said that this would help improve access to new patients outside of the hospital system, in addition to possibly hiring two more physicians around fall.

To improve areas of who receives care, Akins said they were working with their own members to improve who receives care based on their needs to navigate through specific social determinants.

For instance: If someone who cannot afford reliable transportation or even a phone has to choose between health care or daycare for a child, they may forego a doctor visit altogether, thus resulting in a canceled session and the need for someone else who may have needed the slot from also not being met.

“That may potentially affect their health over time, because that’s the core of social determinants,” Akins said.

Other community efforts

In addition to public meetings on “CCO 2.0” in April, Oregon released new legislation to increase activity of CCOs throughout the state. This includes House Bill 4018, which modified requirements for the state’s 15 CCOs.

More specifically, the bill requires that excess financial reserves be put into improving health related to the social determinants Akins and his colleagues mentioned.

Maggie Polson, vice president at CHA, said that this would be nothing new for them.

“It’s not something we’re going to have to change,” Polson said. “It’s just something we’re going to continue to do.”

Polson gave examples such as the group’s recent sponsorship toward Third Thursday events in downtown Klamath Falls, in addition to other activities such as past and future Mills Addition neighborhood projects and the “Walk with a Hero” events organized by the Klamath County School District.

Polson and Akins said that they hope activities such as these would help boost their efforts of preventative health efforts, which in theory would lead to fewer people needing to set up fewer doctor appointments over time.

“Some choices are better than the other, but if we give them all the information we have, we’re hoping we can guide them to those right choices,” Akins said.