Christopher David Gray

CCOs Improve Care Where it Costs Them; Mixed Results Otherwise

The Oregon Health Authority released $47 million in bonus money along with the first annual report on the coordinated care organizations’ efforts to meet 17 quality metrics. The locally operated health plans for Medicaid clients are doing a good job reducing unnecessary ED visits and hospital stays for chronic conditions, but other metrics the state highlight in the report, such as an alleged increase in developmental screenings for children, are misleading.

The Oregon Health Authority released its report on Tuesday to much media fanfare, the first such report with a year’s worth of numbers.

State Fixes Funding Problem for Poor Women’s Contraceptive Care

The Affordable Care Act expanded the state Medicaid program to 350,000 new members, but it didn’t pay providers as well as a separate reproductive health program for uninsured women, provoking concerns from Rep. Mitch Greenlick that the state may be inadvertently hurting Planned Parenthood and other women’s health providers.

The state has stepped in to solve an unintended consequence of the Affordable Care Act -- reproductive health providers had gotten paid less to cover women insured by Medicaid than they did from an existing state program designed specifically to offer free contraceptive services.

Insurance Division Begins Process to Better Regulate Provider Networks

A chief goal of the division is to create more transparency for consumers shopping on Cover Oregon or elsewhere to ensure they know what physicians and services they’ll be getting before they pick a health plan. The division also wants to give clear guidelines to insurers for compliance.

The Oregon Insurance Division is responding to concerns about inadequate networks on Cover Oregon and intends to ask the Legislature for authority to regulate health insurance networks so consumers know upfront whether a plan covers the doctors or other providers they want.

State Review Board Delays Decision on Hep C Coverage Until August

The American Association for the Study of Liver Diseases recommends that Sovaldi be used with patients with late-stage liver disease, but state bureaucrats were ready to block coverage for all patients because of the high price tag of the drug and a report from OHSU’s Center for Evidence-Based Policy that raised red flags about the drug’s studies, helping the state in its attempt to get out of paying for treatment.

A governmental body that meets in Tualatin to determine coverage for Medicaid has deferred a decision on whether the state will require coordinated care organizations to cover pricey drugs that have the promise of curing Hepatitis C.

PEBB Approves Rates for 2015 -- Holding Inflation to 0.7 Percent

Gov. John Kitzhaber proudly wrote of PEBB’s success in controlling costs while offering new options that transform the way healthcare is delivered, aligning the health plan for public employees closer to Oregon’s managed care revolution for Medicaid.

The Public Employees Benefit Board on Tuesday inked the set of health options for public employees and approved premium rates that will rise only 0.7 percent above 2014 premiums -- a second year in a row that premiums have risen less than 1 percent.

PacificSource Tells Insurance Division It Set Its Rate Hike Too High

PacificSource asks the Insurance Division to lower its proposed rate hike from 15.9 percent to 10.8 percent. Providence and Kaiser successfully lobbied the division last year to lower their requested premium rates after they had been priced above the competition.

PacificSource Health Plan has asked the Oregon Insurance Division to correct the filing from what it first a proposed -- an enormous 15.9 percent hike -- and lower it to a 10.8 percent hike, still several times higher than the rate of inflation.

 

State Calls for Community Input to Craft Better Addictions and Mental Health Plan

The federal government requires Oregon to have a strategic behavioral health plan for how it will use block grants. The plan will also help the state comply with the U.S. Department of Justice while integrating the work of the CCOs to lay out how the state will get services to those who need them.

A lot has happened to remake the landscape for the state’s mental health system since Oregon last gave the federal government its strategic plan.

Grand Jury Deliberates Potential Federal Charges in Cover Oregon Debacle

The grand jury meets in secret so there’s little information about the scope of their work or whether criminal charges will come. The governor’s office not only met the deadline to comply with the information request, he promised full cooperation.

A federal grand jury was set to convene in Portland on Tuesday to consider evidence brought forward by U.S. Attorney Amanda Marshall into the debacle known as Cover Oregon and determine whether any federal laws had been violated.

State Hospital Oversight Board Missing More Than Half Its Members

Despite the U.S. Justice Department investigation into Oregon’s mental health system, Gov. Kitzhaber has let a board go unfilled that’s meant to ensure patient safety and care at the state mental hospital. Advisory board members report long lines to get appointed and mishandled applications.

An oversight board tasked with ensuring transparency and accountability at the Oregon State Hospital has been running on empty, with 55 percent of its voting positions vacant.

Task Force Considers Shifting Public Health Away from County Model

A task force created through a 2013 bill from Rep. Mitch Greenlick is considering whether his idea of eight regional public health departments would improve upon 36 stand-alone county health departments in an age of greater insurance access but limited timber revenue to fund these legacy public health departments in many rural counties.

Oregon has traditionally provided public health services through county health departments.

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