PORTLAND, Ore. -- This year marks the 25th anniversary of a unique program that provides in-home care for some of Oregon's most vulnerable residents.

Housecall Providers has expanded to three programs since it began in 1995. At any given time, its primary-care arm serves 1,500 to 1,600 patients. It also has about 120 hospice patients, and provides community-based palliative care for 150 people with serious but non-life-threatening conditions that require wraparound services.

Chief executive Rebecca Ramsay said staff is on call for patients' serious needs.

"If the patient has the flu or is having any kind of exacerbation of their chronic illness, we can make urgent visits as well," she said. "So the difference there is that we're going to the patient on an urgent basis, instead of the patient having to come to an office setting."

In 2017, the nonprofit community-benefits company CareOregon acquired Housecall Providers.

The program's primary-care medical director, Dr. Pamela Miner, said they serve homebound elderly Oregonians, people coping with physical or developmental disabilities, and those with medical or behavioral health challenges. She said the ability to provide house calls allows them to care for so-called "super-utilizers" -- the handful of Medicare beneficiaries that makes up the majority of hospital visits.

"We help prevent expensive trips to the hospital and unnecessary nursing-home stays," she said. "Not only does this set a new standard for the quality of care that patients can expect at home, it improves patient health outcomes, lowers health-care costs and improves the care team's satisfaction as well."

Miner said her team takes COVID-19 precautions on home visits and uses teleconferencing as much as possible.

In 2012, Housecall Providers began participating in the federal Independence at Home demonstration, a Medicare shared-savings model. Still, Ramsay said it's hard to remain financially viable and the program relies on donations. She said home-based service is an option many people want, and it is likely to be in even greater demand as the population ages.

"There's a lot of work to do," she said, "in order to really make sure that the health-care financing system is coming along with us in the recognition of the value of this type of care."

March is Sleep Awareness Month and health experts say Americans are not getting enough of it.

United Health Foundation data found more than 32% of those surveyed said they got fewer than seven hours of sleep, although the rate was slightly better in Oregon at about 28%.

Dr. Kimberly Hutchison, associate professor of neurology and sleep medicine at Oregon Health and Science University, said our culture devalues sleep, with the perception people who get the sleep they need are lazy or not working hard enough.

"Because we live in this accomplishment-driven culture, it results in people sacrificing sleep in order to get other things done," Hutchison explained.

Hutchison pointed out sleep is as important for our health as the food we eat or exercising. The recommended amount of sleep for adults is seven to nine hours in a 24-hour period. For teens and adolescents, it can be as much as 10 hours. For older adults, the number is closer to seven.

Dr. Ravi Johar, chief medical officer for UnitedHealthcare, said one of the best ways to ensure you are getting enough sleep is to have a regular schedule.

"That's something that's really important, just having a routine, whether it's brushing your teeth, changing into pajamas, doing some kind of activity before you go to sleep," Johar outlined. "Yoga, listening to music, reading, things of that sort, setting your alarm for the same time every day."

Johar added people should see a health professional for medical issues such as insomnia or sleep apnea.

"Sometimes there may be underlying medical problems that are making it difficult for you to sleep," Johar noted. "The other thing that's really important that people don't realize is how much stress and behavioral-health issues can factor into their sleep."

It's been 13 years since more than 156,000 West Virginians gained health insurance coverage through the Affordable Care Act.

As sweeping and sometimes controversial as the ACA has been, its longer-term effects are still being felt today at the state level.

Gary Zuckett, executive director of the West Virginia Citizen Action Group, pointed to a new West Virginia law capping insulin copays at $35 per month. The law goes into effect January 1.

"I think we now have the best insulin copay cap legislation in the country that we just helped get passed in a very 'red' legislature," Zuckett noted. "Which does show you that health care is not partisan."

Federal data shows since the launch of the federal health insurance exchange, enrollment in health insurance plans has doubled from 8 million to more than 16 million nationwide.

According to the West Virginia Center on Budget and Policy, the Medicaid expansion included in the ACA allowed more than 200,000 West Virginians to gain access to health coverage.

Zuckett cautioned when the "continuous coverage" rules enacted during the pandemic expire April 1, the state will begin re-evaluating people's eligibility, which could signal a setback in progress.

"A lot of people won't qualify or won't fill out the paperwork, and they'll lose their health insurance in West Virginia," Zuckett explained. "That could be as many as 50 or 100,000 people. So, that's going to be a step backwards."

According to America's Health Rankings, around 6% of West Virginians were uninsured in 2021, far fewer than the nearly 16% of the state's population who lacked coverage prior to the Affordable Care Act.

Beginning next year, more Kentuckians will have expanded access to biomarker testing - which helps doctors customize cancer treatment. Advocates of the new law say it will save lives and improve patients' quality of life.

Signed into law by Gov. Andy Beshear, House Bill 180 requires both private insurers and Medicaid to cover biomarker testing after a cancer diagnosis.

Doug Hogan - director of government relations for the American Cancer Society Cancer Action Network (ACS CAN) - explained that without biomarker testing, doctors typically try several rounds of chemotherapy or other treatments, without knowing which will work best for the patient.

He said biomarkers increase the odds of matching the right treatment to a specific cancer.

"We will be the fifth state in the country to adopt an enhanced access to biomarker testing law," said Hogan. "And so, we're on the cutting edge. This is the way that we can utilize technology to improve health outcomes."

The bill passed unanimously in both the House and Senate. According to the American Cancer Society, more than 30,000 Kentuckians will be diagnosed with cancer this year.

Hogan added that the new law will allow care teams to use the latest technology to make the best decisions for their patients.

"It is so important for these patients to get that right treatment at the right time," said Hogan. "It really will improve their health outcomes. It will save lives in many instances, and certainly will improve the quality of life."

Research shows biomarkers can in many cases reduce the cost of therapy, especially for lung cancer and colorectal cancer patients.

Cancer-care costs are expected to top more than $245 billion by 2030, according to the American Association for Cancer Research.





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