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1. Oregon Health Plan:
Twenty Year Reform Journey from
âThe Listâ to CCOâs
Glenn S. Rodriguez, MD
glenn.rodriguez@providence.org
November 5, 2011
2. Health policy reform in Oregon
over the last two decades
ď 1980âs - Pre-Oregon Health Plan: early
pioneers in managed care in selected cities
ď 1994 - Oregon Health Plan: Prioritized List,
hi-risk pool, created a policy office, aimed for
an employer mandate
ď 2003 - OHP2: reform efforts thwarted with
budget cuts due to recession
ď 2007 - Oregon Health Fund Board: statewide
health reform planning process
ď 2009 - HB 2009/2116 & Oregon Health
Authority
2
3. Original Goals of the
Oregon Health Plan
ď Health care for the uninsured
ď Basic benefit package of effective services
ď Broad participation by providers
ď Decrease cost shifting & charity care
ď A rational way to allocate resources for
health care
3
4. 2003 Recession impacts OHP2
ď Oregon continues to struggle with highest
unemployment in the country as OHP2
changes are implemented
ď Funding cut for adult expansion population
(OHP Standard):
⌠Results in deeper benefit cuts
⌠Loss of coverage for ~80,000 adults on OHP
Standard
⌠24,000 adults maintained by taxes on hospitals
and managed care plans
4
5. As Oregonâs Economy Recovered, New
Reform Energy Emerges
ď Multiple healthcare ballot initiatives & efforts to
gain public input to outline priorities
ď Governorâs HealthyKids initiative
ď Re-focused look at prevention and chronic
diseases via the Prioritized List
ď Health reform plan development
⌠Oregon Health Policy Commission
⌠Senate Interim and 2007 Session Committees
⌠Oregon Business Council & Archimedes
ď Culminated in the creation of the Oregon Health
Fund Board (SB 329) by the 2007 Legislature5
6. Oregon Health Fund Board, 2007-08
ď 7 member citizen board
ď Six committees
⌠Benefits, Eligibility and Enrollment, Finance, Health
Equity, Delivery Systems, Federal Laws
ď Two workgroups
⌠Health Insurance Exchange, Quality Institute
ď Over 110 public meetings with 20 town hall
meetings across state
ď Over 1,500 comments received through
meetings and written comments
7. Oregon Health Fund Boardâs
âAction Plan to Build a Healthy Oregonâ
ď Two track approach:
⌠Expand Coverage
⌠Contain Costs and Improve Quality
ď Keystone: Oregon Health Authority & Health
Policy Board
⌠Single state agency to act as a smart purchaser,
integrator of services, and instigator of innovation
⌠Citizen-led Board provides direction and
accountability
⌠Represents over 850,000 people, or over 25% of
the health care market in Oregon
7
8. HB 2009 â Setting Reform in Motion:
Streamlines State Health Functions
Oregon Health Authority
ď Consolidates state health purchasing and aligns
programs to maximize efficiencies
ď Public Employers Benefits/Oregon Educators
ď Medicaid
ď High Risk Pool and Premium subsidy (FHIAP)
ď Public Health
ď Mental Health and Addictions
Oregon Health Policy Board
ď Guides the Health Authority as it implements
reforms to gain value and reduce costs
9. The Three Goals of
The Oregon Health Authority
ď Improve the lifelong health of Oregonians;
ď Increase the quality, reliability and
availability of care for all Oregonians; and
ď Lower or contain the cost of care so it is
affordable to everyone.
10. Primary Care as the Foundation for
Healthy System Reform
ď Patient Centered Primary Care Home
Standards Work Group
⌠Dr. Rob Stenger, former AAFP resident Board
member, lead staff from OHPR
ď Six core attributes
ď Patient centered language
ď Measures and tiers
ď Attestation, data submission, recognition
11. Attributes
ď Access to Care
⌠âHealth care team, be there when we need youâ
ď Accountability
⌠âTake responsibility for making sure we receive the best possible
health careâ
ď Comprehensive Whole Person Care
⌠âProvide or help us get the health care, information, and services
we needâ
ď Continuity
⌠âBe our partner over time in caring for usâ
ď Coordination and Integration
⌠âHelp us navigate the health care system to get the care we need in
a safe and timely wayâ
ď Person and Family Centered Care
⌠âRecognize that we are the most important part of the care team â
and that we are ultimately responsible for our overall health and
wellnessâ
12. Measures Example: Continuity
ď Must â Pass
⌠Active patients assigned to clinician or team
⌠Measure % visits with assigned clinician/team
⌠Comprehensive health record
⌠Provides hospital care or written agreement with
hospital providers
ď Tier 2
⌠Demonstrates improvement in continuity
measures
ď Tier 3
⌠Performance exceeds benchmark
13. Data Requirements
ď Initial data requirements
⌠Satisfaction survey
⌠Percentage of active patients with assigned
clinician/team
⌠Percentage of visits with assigned clinician/team
⌠Annual experience of care survey on all six
attributes (CAHPS tools recommended)
⌠Results on 2 quality measures from approved list
(30 options)
14. The New Vision:
Coordinated Care Organizations
ď Guided by the OHPB triple aim goals, CCOâs will be the primary
agent for health system transformation
ď New regional community based organizations
⌠âNext generation of Oregon managed care organizationsâ
ď Integration of physical, mental and oral health
⌠âBreak down barriers between silos of care: especially
medical, mental health and long term careâ
ď Global risk for cost of care
⌠âExpectation of new payment methodologies with immediate
savings (already in state budget)â
ď Summary and FAQ at:
http://health.oregon.gov/OHA/OHPB/health-reform/docs/cco-faq.pdf
15. Timeline
ď Oregon Health Policy Board CCO Work
Groups recommendation due Dec. 1, 2011
⌠CCO criteria and governance
⌠Global budget methodology
⌠Medicare / Medicaid integration
⌠Outcomes, quality and efficiency metrics
ď Recommendations to Legislature for Feb,
2012 session
ď Implementation goal: July, 2012
16. Progress to Date:
ď Healthy Kids â 57,000 enrolled
ď End of Life care: POLST registry operational â25,000
enrolled
ď Administrative Simplification Standards passed; to come to
2011 Legislature
ď Strategic planning for health information exchange
ď Implementing primary care medical homes
ď Payment reforms and quality standards being developed
ď Plan for health insurance exchange to go to legislature in
January
ď Held 6 community meetings around Oregon to gain input
on exchange
ď Oregon Health Study on the impact of being uninsured in
America
17. For more information
ď Oregon Health Fund Board materials
available at:
http://www.oregon.gov/OHPPR/HFB/index.html
ď HB 2116 & HB 2009 available at:
http://www.leg.state.or.us/09reg
ď Oregon Health Policy & Research
⌠Website: www.oregon.gov/ohpr
⌠Call us at 503-373-1779