Oregon Plants The Seed Of ObamaCare...

Gov. John Kitzhaber and his health care chiefs have spent the past two years trying to convince anyone who will listen that they can fix some of the health care system's most vexing problems: out-of-control costs and less-than-stellar results.

Starting this week, it's time to prove it.

Oregon created new "coordinated care organizations" charged with taking a more active role in the care of low-income patients on the Oregon Health Plan. The first of those organizations go live on Wednesday with 260,000 patients, and more will launch in the months that follow. Eventually, they'll cover most of the 600,000 people on the Health Plan statewide.

For the patients affected, Wednesday won't be dramatically different from the day before, said officials with several of the seven coordinated care organizations launching that day. They'll keep the same doctor and their benefits will be the same.

But over time, officials said, patients with complex conditions can expect their doctors, nurses and therapists to coordinate their work and to be better prepared to help them handle their treatment between visits to a clinic.

With the system design in place, the responsibility for implementing the plan and coming up with ideas to save billions of dollars shifts to the doctors, hospitals and other organizations that are part of the new coordinated care organizations.

"Now they're going to have to figure out how they modify their delivery system internally, how they're going to eliminate waste, how they're going to actually meet those quality and financial metrics," Kitzhaber said. "So the real creativity, the real innovation is going to be starting now."

The exact model is different for each coordinated care organization. In general, executives said they've prepared for the transition by hiring staff to handle calls from patients and to coordinate their care and investing in new computer systems to share patient records.

"If you're just discharged from the hospital after having a heart attack, those first 30 days are critical for you," said Terry Coplin, chief executive of Trillium Community Health Plan, which will be a coordinated care organization in Lane County. "If you don't understand how to load your medicine containers, you need someone to help you with that. If you have health literacy problems and you don't understand what you need to do as follow up after you get out of the hospital, then you're going to need help with that."