Christopher David Gray

Insurance Division Prepares for Rate Increases in 2015 Using Cost and Quality Metrics

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The information-only data will give the state a baseline to track efforts that health insurance companies are making to temper the cost of healthcare while maintaining a level of quality. Rate requests for 2015 will be released in June, posing the possibility of a high rate increase from Moda, which has dominated plans sold on Cover Oregon.

Health insurers must submit their first set of rate increases after the implementation of Cover Oregon to the Insurance Division by May 31, and this year’s filings will include a whole new set of measurements, forcing insurers to do some math about how they’re keeping costs under control.

The new measures, called “Cost and Quality Metrics” will not be used to approve or adjust rate hikes from the insurance companies. Instead, they’re likely to determine future rate increases by taking a snapshot of healthcare spending and cost controls in 2014. The Legislature and the Insurance Division could put some teeth into these metrics later and hold insurers accountable for avoiding big departures from those numbers in subsequent years.

Thompson Tries to Survive Strong Challenge from the Right

Rep. Jim Thompson is among the most influential Republicans on healthcare issues, serving as the vice-chair of the House Health Care Committee. But his support for same-sex marriage and his compromising demeanor on healthcare reforms has forced him to defend his Dallas-based House district against a conservative eager to take a more provocative approach to politics.

Mike Nearman wants to take the Oregon Republican Party in a new direction, one along Tea Party lines and rid the party of so-called “Republicans In Name Only” that hold sway in the Oregon House. He wants to start with Rep. Jim Thompson, R-Dallas, whom he believes hasn’t done enough to derail the hated Obamacare laws.

“He’s content to just get spoon fed whatever Cover Oregon wants,” said Nearman, an information technology professional and the chairman of the Polk County Republicans. “I wouldn’t let John Kitzhaber get away without answering any questions.”

Portland Police Lieutenant Outlines New Response to Mental Health Crises

Faced with a directive from the U.S. Department of Justice to quell violent encounters between police and people with mental illness, the Portland Police Bureau has begun a behavioral health unit. The director of NAMI commends the force for trying, but an underfunded poorly coordinated mental health system continues to plague Oregon, putting police officers in an unnatural role.

Portland Police Lt. Cliff Bacigalupi was a seasoned street cop when his police chief asked him to head up a new unit designed to address an unintended but growing part of the police force’s scope of practice -- performing triage on the high number of people with mental illness in Portland who are not receiving appropriate care and end up the source of 911 calls.

Policy Board Moves Ahead at Setting Sustainable Growth Rate

A task force will take a measure of overall healthcare spending and the costs for each provider. The state will then use that information to set a benchmark for medical inflation, both in the public and private sectors.

The Oregon Health Policy Board made a baby-step Tuesday in its efforts to tackle rising healthcare costs -- approving a committee to set the groundwork for a legally allowable, sustainable rate of medical inflation for healthcare providers.

When the board finishes it work, it could recommend penalties and rewards to keep providers under a reasonable inflation rate, likely one similar to the rate imposed on the the coordinated care organizations -- 3.4 percent.

Technical Errors Prevent Cover Oregon from Opening Meeting to Public

Cover Oregon tried to open its legislative oversight committee to the public, only to have technical errors shut the meeting down 12 minutes after it began when the public telephone line failed to work.

Cover Oregon tried to open its legislative oversight committee to the public, only to have technical errors shut the meeting down 12 minutes after it began when the public telephone line failed to work.

The Tuesday meeting was intended to be the first public meeting of the legislative oversight committee, which the Legislature had created to oversee the work of Cover Oregon. Little was known about when these meetings were actually taking place because they were kept secretive and held without access to the public or the media, in possible violation of the Public Meetings Law.

Private Homecare Agencies Worry About Competition from State

worker combing senior woman's hair
Some businesses that offer in-home care services have grave concerns about their ability to compete with the state’s home care workers, which nearly derailed SB 1542. But the leader of the Oregon Health Care Association believes that the state won’t be able to compete with his agencies’ cheaper, more comprehensive services.

A new law that will expand the state home care Medicaid registry onto the open market has some private agencies who offer this kind of care worried that the state is butting in on their business.

Other observers maintain that the public option will have little or no effect on their ability to provide quality care to seniors.

Goldberg’s Exit Shifts Medicaid Transformation into Uncertain Waters

Rep. Mitch Greenlick thinks it was a mistake for the governor to “scapegoat” Goldberg for Cover Oregon’s problems. The outgoing Oregon Health Authority director has been at the center of the state’s attempts to expand healthcare access and reform the delivery system for Medicaid. But others think his exit could be a chance to change a dysfunctional culture at the Oregon Health Authority.

The fallout from the Cover Oregon debacle will not be limited to the failed online insurance exchange and could have major repercussions throughout Oregon’s health system and the coordinated care organization reform efforts, largely due to the loss of longtime public servant Dr. Bruce Goldberg.

Last week, Gov. John Kitzhaber announced Goldberg’s resignation -- the health policy leader took responsibility for his role in the state’s failure to effectively manage lackluster web developer Oracle. While Goldberg headed up the Oregon Health Authority, the California technology giant sent Oregon a large infrastructure of bad codes rather than the functioning website it had promised, leaving Oregon as the only state where consumers cannot sign up for private health insurance online without assistance.

Cover Oregon Ejects Reporters from Closed-Door Meeting with Legislators

Cover Oregon
Gov. Kitzhaber announced Tuesday that open enrollment will be extended through April but the exchange is reeling from his announcement last week that top officials would lose their jobs. Cover Oregon staff blocked reporters from a legislative meeting, in possible violation of the Public Meetings Law.

Cover Oregon kicked The Lund Report out of a meeting with top legislators at its Durham headquarters Tuesday, and barred two Statesman-Journal reporters at the door from entering the office.

The reporter from The Lund Report was escorted out of the office by Cover Oregon marketing director Amy Fauver and spokeswoman Ariane Holm, and was told it was a private meeting.

Cover Oregon Audit Released; Goldberg Out Atop Health Authority

Kitzhaber told reporters after the release of the Cover Oregon audit that he was asking Attorney General Ellen Rosenblum to review all legal options against hapless technology contractor Oracle. He said bad management of Oracle contributed to the crippling of the exchange. Cover Oregon debacle has cost one of the most recognizable leaders in state government his job.

Dr. Bruce Goldberg, who left his post as the director of the Oregon Health Authority in December to fill in atop Cover Oregon, will stay on at the insurance exchange until a permanent replacement is found next month, but he will not be returning in any form to the health authority when his work at the exchange is done, Gov. John Kitzhaber told reporters Thursday.

Mercer Report Shows Higher Medical Costs for PEBB in 2013

rising costs
Per-employee medical costs for PEBB through Kaiser are rising about twice as fast as Providence, but the fully insured HMO continues to provide care at less cost than the larger self-insured pool.

The Public Employees Benefit Board saw higher medical costs in 2013 than 2012 for its self-insured health plan administered by Providence after a decline in 2012 from 2011.

The cost of healthcare for the state’s 49,000 employees and 79,000 dependents rose 3.4 percent in per employee costs in 2013 for the self-insured Providence plan, while jumping 6.6 percent for the Kaiser Permanente plan offered through the Public Employees Benefit Board.


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