Change to Oregons health care system is rushing in at warp speed.

At first, the sweeping revamp will affect only Oregons poorest citizens, but may later expand to state workers. Just what this total redesign of state health care will look like and how will it affect rural Oregonians is still quite blurred but its coming fast and set to start this fall.

Stakeholders looked impending changes full in the face Saturday during a public meeting at St. Anthony Hospital led by board members of the Oregon Rural Health Care Association.

Of the quick changeover, Dr. Lisa Dodson said Oregon couldnt afford to dilly-dally.

Our health care system is so badly broken, said Dodson, associate professor at Oregon Health & Science University in Portland and 2009 Oregon Family Doctor of the Year. The speed is frightening, but we havent gotten anywhere making incremental changes.

Its time for revolution, she said, rather than evolution.

Oregon has decided to bite the bullet and go for revolutionary change, Dodson said.

Under this model, enrollees would get their health care from a team of providers called a coordinated care organization (CCO), offering coordinated physical, mental and dental care. The CCOs, scattered around the state, would pay providers from a lump sum, a global budget, instead of a fee for service.

Eleven organizations initially applied to become Umatilla Countys CCO. Only one still stands the Eastern Oregon CCO. The group is actually a duo of risk-bearing organizations: Greater Oregon Behavioral Health, Inc. and ODS Community Health.

Under the new model, prevention will play a huge role, said consultant Bart Murray, representing GOBHI. Along with Umatilla County, the CCO will service 11 other Eastern Oregon counties, including Morrow. The organization isnt dragging its heels.

Were looking at starting Sept. 1, Murray of Baker said.

Murray, like most everyone else, doesnt know exactly how this will play out, but believes the state is zeroing in on a workable, yet affordable, model.

Its exciting to think we have the potential to actually provide better health care at a loser cost, he said.

Much effort will be directed at the 20 percent of Oregon Health Plan patients who use about 80 percent of health care dollars. That could involve monitoring them by phone and other proactive measures that could avert expensive trips to the emergency room.

The conversation drifted to the urban-rural divide and shortage of medical professionals in rural Oregon.

One of my concerns is how its going to play out in rural communities, said Scott Ekblad, director of the Oregon Office of Rural Health.

Art Hill, of Blue Mountain Community College and the Oregon Health Network, pointed to telemedicine as a way to provide access to doctors in other locales. The Oregon Health Network is using a Federal Communications Commission award to install fiber optic lines to rural hospitals and clinics.

Money is another issue. Earlier this month, another CCO applicant, Family Care Community Health, dropped out of the process, leaving only the Eastern Oregon CCO. Jeff Heatherington, president of the sponsoring Family Care Inc., said they simply couldnt afford the deal.

Our loss under the CCO would be $4.5 million, he said, a couple of weeks ago.

Murray, on Saturday, seemed less concerned. He called GOBHI president Kevin Campbell a visionary, who is willing to take risks risks that generally pay off.

Its not going to happen tomorrow, Murray said, but I honestly believe it will work.

Dr. Bruce Carlson, Hermiston family practitioner and president of the Pendleton Independent Practice Association, said after the session, he is reserving his opinion.

Innovation, along with identifying and working with the 20 percent of enrollees who use the bulk of Oregons health care dollars is key, Carlson said.

I think what will make the difference is case management, he said, but are we going to have the funds to do it?

Dodson said the system is going to evolve, because it has to and that Oregon is lighting the way for the nation.

For better or for worse, were a leader in rethinking health care, she said. We get to choose our own pathway instead of waiting for someone else to ram it down our throat.

Contact Kathy Aney at kaney@eastoregonian.com or 541-966-0810.