REEDSPORT, Ore. - Imagine a medical checkup that focuses on how you're doing instead of what's wrong.

A growing number of small-town health clinics in Oregon are reorganizing their practices to become "medical homes." Patients are able to call on a team, not just a doctor, for health questions and recommendations.

On the coast, some clinics in the Columbia Pacific Coordinated Care Organization have adopted the medical-home model. Mindy Stadtlander, a clinical systems innovation program manager for CareOregon, helped with the transition and said it's a more neighborly way to improve patient care.

"The provider and the team that takes care of them knows about them. They know their family, they know their history," she said. "They can call them in for visits when they haven't been in for a long time and they're needing some up-to-date prevention or other health screenings."

The focus in a medical home is on staying healthy and managing chronic conditions, explained Stadtlander, which also saves money, rather than waiting until a problem becomes serious to get care. The care team looks beyond a person's medical chart, sometimes recommending social services or community activities.

The medical-home model has built-in challenges in rural areas, where clinics are small and there's a shortage of providers.

Dr. Janet Patin, a family practitioner who moved from Ohio to Reedsport to be part of Oregon's health-care transformation, said she thinks other doctors would do the same.

"This is really exciting medicine - to be able to give people better care, the care that we know we can provide, that people deserve," said Patin, who practices at Dunes Family Health Care. "That's going to be a recruiting benefit. I think people are going to want to be part of that, as providers."

The biggest challenge isn't geography, she said; it's getting people to see the health-care system, and their role in it, differently.

"What we're trying to do," she said, "is shift patients' to thinking, 'I am the most important member of my health-care team,' you know. 'How can you help me be healthier?' You don't go to the doctor and say, 'Fix me.' "

Patin said small towns have one advantage in setting up medical homes, because the providers often are well acquainted with patients and their families.


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.