Portland, Ore., May 11, 2009 — One hundred years ago, you only visited the doctor when you were sick or injured. A bandage, a prescription, then off you’d go, on your own again until the next time you needed help. Essentially, "acute care" is how medicine is still practiced today. But the greatest share of medical costs is from treating people with chronic conditions. An estimated 133 million Americans have one or more chronic diseases, and care for them accounts for 75 percent of the $2 trillion in annual care costs. Clearly, the acute care model is obsolete and is contributing to the steep increase in health care costs. Two Oregon organizations—CareOregon and the Oregon Primary Care Association (OPCA)—are the recipients of a grant to expand an alternative that promises to be a valuable tool in health care reform. The National Medical Home Initiative for Safety-Net Clinics is a groundbreaking four-year project to improve health care delivery across the United States. The grant will support health centers that serve the vulnerable and disadvantaged in achieving high performance through a patient-centered medical home (PCMH) model of delivery. The PCMH is also known as the primary care home or integrated health home model.

Under the initiative, CareOregon and OPCA will work together as a Regional Coordinating Center for the PCMH model. The Center will receive $125,000 per year for four years to build upon existing health policy and technical assistance and training programs at 13 clinics across Oregon. "Our ultimate goal," said Craig Hostetler, OPCA executive director, "is to expand the PCMH model among safety net and other primary care clinics throughout the state." Page 2 of 6

CareOregon is the state’s largest Medicaid managed care organization, and OPCA represents clinics that care for more than 20 percent of both the Medicaid and the uninsured populations. Both organizations have already demonstrated a commitment to the concept by launching PCMH pilot projects. CareOregon has been working with six clinics in its Primary Care Renewal project since 2006. OPCA has focused on the PCMH model as a major goal for the last four years. In addition, in order to promote the spread of medical homes in other safety net clinics, CareOregon and OPCA worked with the Oregon Rural Practice Research Network (ORPRN) to identify two Rural Health Clinics to participate in the initiative. "This is a tremendously exciting opportunity for us to be a part of a national dialogue and initiative to make the PCMH the new model of care in primary practice," said David Labby, MD, PhD, CareOregon medical director. In the acute care model, doctors focus on patient visits. Under the patient-centered medical home model, a team consisting of panel managers, medical assistants and behavioral health specialists as well as primary care providers (doctors, nurse practitioners or physician assistants) focus on every patient and works to make the population stay healthy or get better. When a patient comes in for a visit, the team addresses all issues they’ve identified: preventive screenings, overdue exams or whatever else is needed. The team, rather than the patient, may even initiate the visit if it’s warranted. "The PCMH model represents a paradigm shift for primary care providers, allowing them to focus on the health of all their patients, rather than just focusing on office visits," Labby said. CareOregon will be the clinical lead for the initiative, responsible for integrating the organizations’ current learning networks into a broader medical home learning network. OPCA will be the fiscal agent and lead for working with stakeholders to support the sustainability and spread of patient-centered medical homes through health policy. The clinics will be supported by OPCA, CareOregon and ORPRN staff. The Qualis Health grant will provide funding for additional staff, materials and external expertise to expand and enhance the patient-centered medical home model. "We're grateful to the funders of this initiative for supporting our work," Hostetler said. "I would like to thank in particular the partnership between The Commonwealth Fund and our local funder, the Northwest Health Foundation. They have been generous in supporting the medical home model, and they have also been key partners in our work regarding comprehensive health care reform in Oregon." Collectively, the clinics participating in the initiative will serve 189,000 patients across Oregon. They include 16 percent of the state’s Medicaid patients and 12 percent of all uninsured patients. "Many of our patients have complex medical, behavioral health and social issues," Hostetler noted. "By demonstrating that the PCMH model works for them, we hope to encourage its adoption throughout the broader health care community." Page 3 of 6

The Commonwealth Fund is a private foundation that aims to promote a high-performing health care system that achieves better access, improved quality and greater efficiency, particularly for society’s most vulnerable. www.commonwealthfund.org Qualis Health

Quails Health, an independent nonprofit organization established in 1974, and headquartered in Seattle, is dedicated to developing and applying best practices while delivering an extensive range of patient-centered, evidence-based healthcare quality improvement and care management services. www.qualishealth.org MacColl Institute for Healthcare Innovation

The MacColl Institute for Healthcare Innovation at Group Health Center for Health Studies aims to bridge the worlds of research and practice through the development, evaluation and dissemination of improvements in care, through a program of identifying, developing and testing innovations in caring for individuals and disease-specific patient populations. In the mid-1990s the Institute developed the Chronic Care Model approach to improving ambulatory care. Northwest Health Foundation The mission of the Northwest Health Foundation is to advance, support and promote the health of the people of Oregon and Southwest Washington. The foundation has been investing in programs and projects since 1997, working to improve the health of the people in this region. Page 4 of 6

Outside In Kathy Oliver, CEO 1132 SW 13th Ave. Portland, OR 97205-1703 503-535-3800 www.outsidein.org/clinic.htm Page 5 of 6

CareOregon Primary Care Renewal clinics Central City Concern Old Town Clinic Ed Blackburn, CEO 727 W Burnside Portland, OR 97209 503-228-4533 www.centralcityconcern.org/oldtown.htm Legacy Clinic Emanuel George Brown, MD, CEO 2800 N Vancouver Ave., Suite 230 Portland, OR 97227 503-413-2901 www.legacyhealth.org/body.cfm?id=287 Multnomah County Health Department Amit Shah, MD, CEO Mid-County Health Center 12710 SE Division Portland, 97236-3134 503-988-3601 East County Health Center 600 NE Eighth Ave., Third Floor Gresham, OR 97030 503-988-5155

OHSU Family Medicine at Richmond Ann O’Connell, Executive Director 3930 SE Division Portland, OR 97202 503-418-3900 www.ohsu.edu/health/clinics-and-services/clinic.cfm?id=11481 OHSU Family Medicine at Scappoose Diane Hudson, clinic manager 51377 Old Portland Road, Suite C Scappoose, OR 97056 503-418-4222 www.ohsu.edu/health/clinics-and-services/clinic.cfm?id=11482 Virginia Garcia Memorial Health Center Gil Munoz, CEO 85 N 12th Ave. Cornelius, OR 97113 503-359-5564 www.virginiagarcia.org/cornelius.html Page 6 of 6

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