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

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Original Goals of the Oregon Health Plan

Health care for the uninsuredBasic benefit package of effective servicesBroad participation by providersDecrease cost shifting & charity careA rational way to allocate resources for

health care

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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

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As Oregon’s Economy Recovered, New Reform Energy Emerges

Multiple healthcare ballot initiatives & efforts to gain public input to outline priorities

Governor’s HealthyKids initiativeRe-focused look at prevention and chronic

diseases via the Prioritized ListHealth 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 Legislature

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Oregon Health Fund Board, 2007-08

7 member citizen boardSix 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 Oregon7

HB 2009 – Setting Reform in Motion: Streamlines State Health Functions

Oregon Health AuthorityConsolidates 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 BoardGuides 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 providersTier 2◦Demonstrates improvement in continuity

measuresTier 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 enrolledEnd of Life care: POLST registry operational –25,000

enrolledAdministrative Simplification Standards passed; to come to

2011 LegislatureStrategic planning for health information exchangeImplementing primary care medical homesPayment reforms and quality standards being developedPlan for health insurance exchange to go to legislature in

JanuaryHeld 6 community meetings around Oregon to gain input

on exchangeOregon 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