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Oregon Health Plan:
Twenty Year Reform Journey from
      “The List” to CCO’s


                Glenn S. Rodriguez, MD
        glenn.rodriguez@providence.org
                      November 5, 2011
Health policy reform in Oregon
          over the last two decades

   1980’s - Pre-Oregon Health Plan: early
    pioneers in managed care in selected cities
   1994 - Oregon Health Plan: Prioritized List,
    hi-risk pool, created a policy office, aimed for
    an employer mandate
   2003 - OHP2: reform efforts thwarted with
    budget cuts due to recession
   2007 - Oregon Health Fund Board: statewide
    health reform planning process
   2009 - HB 2009/2116 & Oregon Health
    Authority
                                               2
Original Goals of the
             Oregon Health Plan

   Health care for the uninsured
   Basic benefit package of effective services
   Broad participation by providers
   Decrease cost shifting & charity care
   A rational way to allocate resources for
    health care




                                            3
2003 Recession impacts OHP2

   Oregon continues to struggle with highest
    unemployment in the country as OHP2
    changes are implemented
   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
As Oregon’s Economy Recovered, New
          Reform Energy Emerges
   Multiple healthcare ballot initiatives & efforts to
    gain public input to outline priorities
   Governor’s HealthyKids initiative
   Re-focused look at prevention and chronic
    diseases via the Prioritized List
   Health reform plan development
    ◦ Oregon Health Policy Commission
    ◦ Senate Interim and 2007 Session Committees
    ◦ Oregon Business Council & Archimedes
   Culminated in the creation of the Oregon Health
    Fund Board (SB 329) by the 2007 Legislature5
Oregon Health Fund Board, 2007-08

   7 member citizen board
   Six committees
    ◦ Benefits, Eligibility and Enrollment, Finance, Health
      Equity, Delivery Systems, Federal Laws
   Two workgroups
    ◦ Health Insurance Exchange, Quality Institute
   Over 110 public meetings with 20 town hall
    meetings across state
   Over 1,500 comments received through
    meetings and written comments
Oregon Health Fund Board’s
“Action Plan to Build a Healthy Oregon”

   Two track approach:
    ◦ Expand Coverage
    ◦ Contain Costs and Improve Quality
   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
HB 2009 – Setting Reform in Motion:
     Streamlines State Health Functions
Oregon Health Authority
   Consolidates state health purchasing and aligns
    programs to maximize efficiencies
        Public Employers Benefits/Oregon Educators
        Medicaid
        High Risk Pool and Premium subsidy (FHIAP)
        Public Health
        Mental Health and Addictions
Oregon Health Policy Board
   Guides the Health Authority as it implements
    reforms to gain value and reduce costs
The Three Goals of
          The Oregon Health Authority

   Improve the lifelong health of Oregonians;
   Increase the quality, reliability and
    availability of care for all Oregonians; and
   Lower or contain the cost of care so it is
    affordable to everyone.
Primary Care as the Foundation for
          Healthy System Reform

   Patient Centered Primary Care Home
    Standards Work Group
    ◦ Dr. Rob Stenger, former AAFP resident Board
      member, lead staff from OHPR
   Six core attributes
   Patient centered language
   Measures and tiers
   Attestation, data submission, recognition
Attributes
   Access to Care
    ◦ “Health care team, be there when we need you”
   Accountability
    ◦ “Take responsibility for making sure we receive the best possible
      health care”
   Comprehensive Whole Person Care
    ◦ “Provide or help us get the health care, information, and services
      we need”
   Continuity
    ◦ “Be our partner over time in caring for us”
   Coordination and Integration
    ◦ “Help us navigate the health care system to get the care we need in
      a safe and timely way”
   Person and Family Centered Care
    ◦ “Recognize that we are the most important part of the care team –
      and that we are ultimately responsible for our overall health and
      wellness”
Measures Example: Continuity

   Must – 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
   Tier 2
    ◦ Demonstrates improvement in continuity
      measures
   Tier 3
    ◦ Performance exceeds benchmark
Data Requirements

   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)
The New Vision:
          Coordinated Care Organizations
   Guided by the OHPB triple aim goals, CCO’s will be the primary
    agent for health system transformation
   New regional community based organizations
    ◦ “Next generation of Oregon managed care organizations”
   Integration of physical, mental and oral health
    ◦ “Break down barriers between silos of care: especially
      medical, mental health and long term care”
   Global risk for cost of care
    ◦ “Expectation of new payment methodologies with immediate
      savings (already in state budget)”
   Summary and FAQ at:
http://health.oregon.gov/OHA/OHPB/health-reform/docs/cco-faq.pdf
Timeline

   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
 Recommendations to Legislature for Feb,
  2012 session
 Implementation goal: July, 2012
Progress to Date:

   Healthy Kids – 57,000 enrolled
   End of Life care: POLST registry operational –25,000
    enrolled
   Administrative Simplification Standards passed; to come to
    2011 Legislature
   Strategic planning for health information exchange
   Implementing primary care medical homes
   Payment reforms and quality standards being developed
   Plan for health insurance exchange to go to legislature in
    January
   Held 6 community meetings around Oregon to gain input
    on exchange
   Oregon Health Study on the impact of being uninsured in
    America
For more information

   Oregon Health Fund Board materials
    available at:
    http://www.oregon.gov/OHPPR/HFB/index.html
   HB 2116 & HB 2009 available at:
    http://www.leg.state.or.us/09reg
   Oregon Health Policy & Research
    ◦ Website: www.oregon.gov/ohpr
    ◦ Call us at 503-373-1779
HB 2116 – Expanding Coverage

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Rodriguez or cc os

  • 1. Oregon Health Plan: Twenty Year Reform Journey from “The List” to CCO’s Glenn S. Rodriguez, MD glenn.rodriguez@providence.org November 5, 2011
  • 2. Health policy reform in Oregon over the last two decades  1980’s - Pre-Oregon Health Plan: early pioneers in managed care in selected cities  1994 - Oregon Health Plan: Prioritized List, hi-risk pool, created a policy office, aimed for an employer mandate  2003 - OHP2: reform efforts thwarted with budget cuts due to recession  2007 - Oregon Health Fund Board: statewide health reform planning process  2009 - HB 2009/2116 & Oregon Health Authority 2
  • 3. Original Goals of the Oregon Health Plan  Health care for the uninsured  Basic benefit package of effective services  Broad participation by providers  Decrease cost shifting & charity care  A rational way to allocate resources for health care 3
  • 4. 2003 Recession impacts OHP2  Oregon continues to struggle with highest unemployment in the country as OHP2 changes are implemented  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 Oregon’s Economy Recovered, New Reform Energy Emerges  Multiple healthcare ballot initiatives & efforts to gain public input to outline priorities  Governor’s HealthyKids initiative  Re-focused look at prevention and chronic diseases via the Prioritized List  Health reform plan development ◦ Oregon Health Policy Commission ◦ Senate Interim and 2007 Session Committees ◦ Oregon Business Council & Archimedes  Culminated in the creation of the Oregon Health Fund Board (SB 329) by the 2007 Legislature5
  • 6. Oregon Health Fund Board, 2007-08  7 member citizen board  Six committees ◦ Benefits, Eligibility and Enrollment, Finance, Health Equity, Delivery Systems, Federal Laws  Two workgroups ◦ Health Insurance Exchange, Quality Institute  Over 110 public meetings with 20 town hall meetings across state  Over 1,500 comments received through meetings and written comments
  • 7. Oregon Health Fund Board’s “Action Plan to Build a Healthy Oregon”  Two track approach: ◦ Expand Coverage ◦ Contain Costs and Improve Quality  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 – Setting Reform in Motion: Streamlines State Health Functions Oregon Health Authority  Consolidates state health purchasing and aligns programs to maximize efficiencies  Public Employers Benefits/Oregon Educators  Medicaid  High Risk Pool and Premium subsidy (FHIAP)  Public Health  Mental Health and Addictions Oregon Health Policy Board  Guides the Health Authority as it implements reforms to gain value and reduce costs
  • 9. The Three Goals of The Oregon Health Authority  Improve the lifelong health of Oregonians;  Increase the quality, reliability and availability of care for all Oregonians; and  Lower or contain the cost of care so it is affordable to everyone.
  • 10. Primary Care as the Foundation for Healthy System Reform  Patient Centered Primary Care Home Standards Work Group ◦ Dr. Rob Stenger, former AAFP resident Board member, lead staff from OHPR  Six core attributes  Patient centered language  Measures and tiers  Attestation, data submission, recognition
  • 11. Attributes  Access to Care ◦ “Health care team, be there when we need you”  Accountability ◦ “Take responsibility for making sure we receive the best possible health care”  Comprehensive Whole Person Care ◦ “Provide or help us get the health care, information, and services we need”  Continuity ◦ “Be our partner over time in caring for us”  Coordination and Integration ◦ “Help us navigate the health care system to get the care we need in a safe and timely way”  Person and Family Centered Care ◦ “Recognize that we are the most important part of the care team – and that we are ultimately responsible for our overall health and wellness”
  • 12. Measures Example: Continuity  Must – 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  Tier 2 ◦ Demonstrates improvement in continuity measures  Tier 3 ◦ Performance exceeds benchmark
  • 13. Data Requirements  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  Guided by the OHPB triple aim goals, CCO’s will be the primary agent for health system transformation  New regional community based organizations ◦ “Next generation of Oregon managed care organizations”  Integration of physical, mental and oral health ◦ “Break down barriers between silos of care: especially medical, mental health and long term care”  Global risk for cost of care ◦ “Expectation of new payment methodologies with immediate savings (already in state budget)”  Summary and FAQ at: http://health.oregon.gov/OHA/OHPB/health-reform/docs/cco-faq.pdf
  • 15. Timeline  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  Recommendations to Legislature for Feb, 2012 session  Implementation goal: July, 2012
  • 16. Progress to Date:  Healthy Kids – 57,000 enrolled  End of Life care: POLST registry operational –25,000 enrolled  Administrative Simplification Standards passed; to come to 2011 Legislature  Strategic planning for health information exchange  Implementing primary care medical homes  Payment reforms and quality standards being developed  Plan for health insurance exchange to go to legislature in January  Held 6 community meetings around Oregon to gain input on exchange  Oregon Health Study on the impact of being uninsured in America
  • 17. For more information  Oregon Health Fund Board materials available at: http://www.oregon.gov/OHPPR/HFB/index.html  HB 2116 & HB 2009 available at: http://www.leg.state.or.us/09reg  Oregon Health Policy & Research ◦ Website: www.oregon.gov/ohpr ◦ Call us at 503-373-1779
  • 18. HB 2116 – Expanding Coverage