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Rodriguez or cc os Presentation Transcript

  • 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 FunctionsOregon 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 AddictionsOregon 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