Portland, is a patient satisfaction survey. The survey identifies the clinician and asks eight basic questions about his or her interaction.
"It's mostly about that care experience," Tilford said. "Did they listen? Did they explain things? Were they courteous? Were they respectful?"
The feedback-along with actual patient comments-is given to the physicians, who are allowed to make their own improvements.
"Our perspective is we're changing at a rate that we've never changed before," Tilford said.
OHSU is the fourth big player in Portland. The system operates University
Hospital and Doernbecher Children's Hospital, with a total of 338 beds.
OHSU also has its own multispecialty practice with 450 physicians.
"To a large degree they're focused on being part of a statewide network" called Health Future, Rutledge said.
The network of 17 hospitals and 17 medical groups has signed a letter of intent to serve PACC's HMO and other insurance plans covering 120,000 people in the state, said Tim Goldfarb, CEO of OHSU's healthcare system.
Historically, 50% of OHSU's patients have come from outside the Portland area through referrals from Health Future providers.
OHSU will become a public corporation July 1, following legislation enacted last month. That will free it from the state regulations that have hindered forming alliances with other entities (Jan. 30, p. 20). As a public corporation, it will be able to enter into joint ventures that involve equity and risk sharing.
The alliance with PACC will not preclude other deals, Goldfarb said.
"We're trying to be accessible to everyone, to be a partner to everyone, a Switzerland in the marketplace," he said.
OHSU does not want to develop exclusive relationships because that would restrict access to patient care, which supports the system's teaching role.
Because OHSU also serves PacifiCare enrollees, young faculty members and residents receive training in capitation and managed care, Goldfarb said.
And OHSU is a provider for the Oregon Dental Service's HMO and PPO, PACC, the Blues' PPO, Providence and Kaiser.
In conjunction with its decision to phase out Bess Kaiser hospital,
Kaiser announced plans to establish a center of excellence in pediatrics at OHSU. Joining with Kaiser will make it more attractive to managed-care payers. "With health plans, access to women and children is critical,"
OHSU also has partnered with Multnomah and Clackamas counties and public health clinics throughout the state to form Care Oregon, a public HMO serving about 20,000 Medicaid enrollees in the Oregon Health Plan.
Another significant presence in the metropolitan market is Portland
Adventist Medical Center, staffed for 257 beds. It has a medical staff of more than 300 physicians. Part of Adventist Health System/West, based in
Roseville, Calif., the hospital is affiliated with Portland Adventist Group, which has 72 primary-care physicians at 27 clinic sites.
Adventist formed a joint venture with Legacy called Managed Health Northwest, with Legacy owning 75% and Adventist 25%. The venture is the source of a number of contracts with HMOs such as the Blues' HMO Oregon, PacifiCare and Qual-Med Oregon Health Plan, said Larry Dodds, Portland Adventist Medical Center's president.
Legacy and Adventist also are in a joint venture to operate their mental health plans collaboratively.
Dodds said the independent hospital is not considering mergers, adding that the facility has "done well financially for many years." The facility has accepted capitation contracts since January, "and it seems to be working," he said. With outpatient services growing under capitation, its average census is about 110 patients.
Developing management information systems will be Adventist's biggest challenge over the next several years. The corporate office is developing such systems, and the hospital does not yet know how much it needs to spend, a spokesman said.
Portland also has a Department of Veterans Affairs hospital and a Shriner's hospital for children.
Despite the keen competition, "an amicable approach" characterizes the Portland market, the state association's Rutledge said. This has led to a unique form of collaboration among the major players.
Added Legacy's King: "What we're trying to figure out is how to work out a collaborative/competitive model. We'll compete for the HMO business and the enrollment, but we'll try to collaborate on health status issues. It's a very enlightened approach, but it's also very hard work. It's going to take time to build some trust and the infrastructure to know how to work together."
The collaboration already has resulted in Legacy, Providence and OHSU combining their separate helicopter ambulance programs and in a communitywide childhood immunization program. Regional prenatal and child-abuse programs are about to be launched.
With mature systems and health plans collaborating when they can and competing on price and quality for the healthcare dollar, providers believe they are giving purchasers and consumers good value.
That value will probably increase in response to pressure from employers such as Portland General Electric Corp., 60% of whose 1,600 salaried employees have chosen one of the five HMOs the company offers. "We play the providers off one another," said Rand Sherwood, director of human resources. "They're really competing for our business. It's in the best interest of everyone," he said.
Premiums have been trending down in the past five years. Still, Portland General Electric spends about $10 million a year on healthcare, which is 8% to 9% of the company's annual payroll of $120 million. Sherwood said that's still too high.
"I see consolidation in the future. I'm not sure we can sustain five HMOs," he added.
With price competition keen, "quality of care is not suffering," Sherwood said. `