Illustration by Alex DeSpain

STEVE NOVICK'S BUSY.

Last month, the rookie city commissioner found himself atop the troubled Portland Bureau of Transportation—too broke to fix Portland's roads, let alone address other needs. It's a big, important bureau, and it's not Novick's only assignment. He's got to look after the city's emergency communications and earthquake preparations.

But the commissioner's also got an insatiable interest in something not in his official portfolio: health care policy. And he's not letting his bureaus get in the way of an extracurricular effort he promised to tackle well before he took office. He's trying to fix the system.

In meetings that began in April, Novick has been connecting unions, bureaucrats, and businesses—from across the region—for a conversation on what's working, and what isn't, in the region's health care system. It's unclear what kind of changes, if any, will result. For now, there's mostly a sense of cautious optimism.

"It's kind of unprecedented," says Jill Freeman, of the Oregon Coalition of Health Care Purchasers, who's attended one of the meetings. "He has really led the charge on creating a forum."

Most participants are reticent to publicly discuss the talks—some wouldn't talk at all. A representative from Precision Castparts declined to comment. TriMet said any discussion of possible fixes is premature. Multnomah County also didn't want to talk much about the substance of the discussions, saying only that it welcomed any chance to talk about health care.

But others say the meetings have unearthed some hopeful solutions.

Always on the lookout for new national models, Novick has been advocating something called "hot spotting," where customers who use the system at inordinately high rates—say, with frequent emergency room or urgent care visits—actually work with their providers to figure out why. Novick snatched the idea from a New Yorker article that described a similar program in Atlantic City. He's since pitched it to TriMet and its operators' union, Amalgamated Transit Union Local 757, as a way to cut costs—a major fault line in what's been a bitter contract fight.

"It's something we're interested in having more information on," says Bruce Hansen, the union's president.

"We feel it is premature to talk about it because it is just one of the options we are looking at right now," says Roberta Altstadt, a TriMet spokeswoman.

Michael Hanna, president of the American Federation of State, County, and Municipal Employees Local 88, who represents the bulk of Multnomah County employees, is more decisive.

"We're definitely going to look at it," says Hanna. "For the county, it's not a question of if we're going do it. It's a question of when."

Novick talks about a similar fix to the city's 911 system. Instead of having dispatchers flag callers for an ambulance ride after a few questions, the commissioner's been contemplating a more "fine-grained" approach.

"If [callers] don't seem to be in immediate danger, [dispatchers] ask a couple more questions," Novick says.

Those kinds of questions can prevent unnecessary hospital trips, but take up more of dispatchers' time. So Novick's been talking with local health care behemoth Kaiser Permanente to see if it's willing to pay for additional dispatchers.

"If we were able to reduce the number of visits Kaiser gets, that would save them money," Novick says. "Would they be willing to kick in, then?"

The focused discussions come at a time of steadily rising health care costs. The city's costs for employee health care—not including dental and vision insurance— have risen more than 50 percent in the past decade, and the county's also seen steady upticks. At the same time, there's lingering uncertainty over what role the federal Affordable Care Act—AKA Obamacare—will play as its staggered rollout continues next year.

"It stems from all of us coming to the same conclusion: that the current trajectory for health care costs is unsustainable," says Hanna. "Working together is the only way we're going to solve this thing."

Novick, as is his style, is looking into bringing national experts on the models he advocates to Portland. He concedes the work isn't necessarily part of his job description, but argues curbing health care costs is vitally important for the region.

"Building sustainability centers doesn't necessarily fall into the job of commissioners either," he says, nodding to former Mayor Sam Adams' effort to build a world-leading green technology center. "There's a ton of work to be done, but every other week I read something in the New York Times that's a new idea that I've never heard of before."