SALEM, Ore. (AP) -- An ambitious plan to change the way people get their health care is on its way to reality after the Oregon Senate voted Tuesday to advance Gov. John Kitzhaber's effort to focus on coordinating care and rewarding doctors for healthy patients.

After beating back a Republican effort to limit liability in medical malpractice cases, senators voted to let the state begin certifying coordinated care organizations as soon as July 1. The new regional organizations would be responsible for integrating care from doctors, dentists and mental health experts for Oregon Health Plan patients in their area.

The changes would apply directly to 600,000 patients with state-funded health care, but officials say many others will see an impact as the health care system adapts.

Kitzhaber hopes the overhaul would make Oregon among the first states to get a handle on rapidly rising health care costs, which threaten funding for schools, police and other government programs. Proponents say the health care system could save billions by eliminating duplicated procedures and properly managing chronic conditions like diabetes and heart disease so patients can avoid expensive care in emergency rooms.

"The vote today brings us one step closer to creating a more sustainable health care system through improved health and reduced waste and inefficiency," Kitzhaber said in a statement.

Skeptics worry the proposal is being implemented too quickly, that there's not enough money to make it work effectively or that it creates incentives to deny care. Proponents say their plan addresses those concerns.

"It will not work. It is going to fail," said Sen. Fred Girod, R-Stayton, a dentist who said he'd prefer approaches like raising co-pays that might discourage patients from seeking unneeded care.

The Senate's approval followed weeks of rising tension over GOP efforts to add new limits on medical malpractice liability for health care providers involved with coordinated care organizations. Democratic Sen. Betsy Johnson of Scappoose joined Republicans last week in a pledge to block the measure if it did not include liability limits.

But Johnson changed her mind, providing the final vote. She said she was swayed by legal memos questioning the constitutionality of the proposed liability limits and warning that they might unravel protections already in place for Oregon Health and Science University.

After it passed on a party-line vote, Republican Sens. Bruce Starr of Hillsboro and Jackie Winters of Salem broke ranks and changed their votes to support the legislation. In the end, it passed 18-12.

The measure next goes to the House, where a key Republican has been heavily involved in drafting it and lawmakers from both parties have repeatedly said it's likely to pass.

The Legislature approved the concept for Kitzhaber's initiative last year, telling him to work out the details and return for approval. Senate Bill 1580 would approve an implementation plan worked out over much of the last year.

Kitzhaber's overhaul would focus in particular on patients with chronic diseases, mental illnesses and addictions, who account for the largest share of health care spending. Proponents envision new efforts to keep in touch with those patients, ensuring they're making medical appointments and taking medications. They also want to improve follow-up care after patients are discharged from the hospital to reduce re-admissions.

A state-funded report says the plan would save at least $3.1 billion over five years.

"This bill transforms for the better the way our state delivers care for those in need," said Sen. Laurie Monnes Anderson, D-Gresham. Although the changes apply initially to people on the Oregon Health Plan -- the state's version of Medicaid for low-income patients -- many others are likely to see an impact because everyone uses the same health care system, officials say.

The plan relies heavily, for example, on the adoption of electronic medical records to share patient information. It encourages medical practices to become certified as primary care health homes, which requires them to meet standards and be available after hours or on the telephone.

Kitzhaber and his allies in the Legislature say the overhaul would put Oregon at the forefront of national health reform efforts. Successful implementation here would show the potential for cost savings and provide a path that other states or the federal government could follow, they say.

Sen. Doug Whitsett wasn't sure that's a good thing.

"We are offering up Oregon as a grand West Coast test ground, a grand experiment, to see if the Affordable Care Act will work," Whitsett said, using the formal name for a federal health overhaul that critics call Obamacare. "I'm not willing to do that."

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