An Obamacare Story: How the Controversial Law is Encouraging Out-of-the-box Thinking

I am not attending the Health 2.0 conference in Santa Clara, but the Twitter stream revealed a jewel that just begs to be shared.

Forbes contributor Dan Munro tweeted about Oregon Governor John Kitzhaber and his decision to use Medicaid dollars to buy air conditioners for people with congestive heart failure.

Here's how the story goes, as reported by Washington Post blogger Ezra Klein a few months ago.

A very hot day can have catastrophic consequences for a person with congestive heart failure. A 90-year-old woman in Oregon with this condition could easily end up with full-blown heart failure because soaring temperatures can put pressure on her cardiovascular system.

Pre-Obamacare philosophy dictated that Medicare would pay for the emergency care to stabilize her - in other words pay for the ambulance and $50,000 in costs associated with her care, Kitzhaber told Klein. 

That's treating the effect and not the cause. All she needs is really a $200 air conditioner, Kitzhaber reasoned. If Medicare did foot that $200 bill, it would save $49,800.

And that's nothing to joke about.

So, Kitzhaber took a gamble. He made a deal with the Obama administration by which he asked for $1.9 billion to help redesign the state's Medicaid program. By this the state's 15 "coordinated care organizations (CCO)" charged not only with managing the health of individual members, 94% of whom are on Medicaid, but the community as a whole, had discretion and say over what they spend Medicaid dollars on. 

A gamble because if that $1.9 billion funding from the federal government doesn't bring the $11.9 billion in savings over the next decade, those funds "dry up" and instead Oregon is left with a budget hole.

The risk appears worth taking. Because what Kitzhaber is betting on is that coordinated care will lower costs over time. As the article notes, Oregon is investing in people's health instead of providing people episodic treatment that never digs deeper to solve the real health question.

Klein's blog also referred to the fact that one CCO is paying pregnant women not to smoke.

Kitzhaber's radical approach of course needs to be commended. That's the sort of creative thinking that can occur if Obamacare can be viewed as an opportunity rather than a threat.

The medical device industry that has viewed the health law through a skeptical and fearful lens and in general large businesses with entrenched processes, products and philosophies would do well to heed this Obamacare story. 

Is there an AC ("air conditioner") solution to a healthcare (HC) industry problem in your company? Share your thoughts using the Twitter widget below and the #achcmddi hashtag.

[Photo Credit: iStockphoto.com user heizfrosch] 

-- By Arundhati Parmar, Senior Editor, MD+DI
[email protected]