Oregon’s dominant healthcare players are expected to make major announcements in the coming weeks that could transform the landscape, The Lund Report has learned.
For starters, the Oregon Association of Hospitals and Health Systems intends to release its 2014 hospital profile book that will cover trends for the past five years through 2013, according to Andy Van Pelt, chief operating officer, who gave a draft copy of the summary document of 2013 data to The Lund Report on background, saying his association’s members needed to review the entire document at its membership meeting before it could be publicly released.
This document will shed light on several key factors influencing Oregon’s hospitals – pinpointing each facility while also giving a cumulative look at the latest trends. The data includes: operating margins of the 62 hospitals, their inpatient and outpatient load, the number of babies born at each hospital; payment mix – uncompensated care, private pay, Medicare and Medicaid, and the number of people receiving care in the emergency room departments of each hospital.
Since the data collected in this report comes from the hospitals themselves, rather than an independent audit, there’s no way of accurately knowing its validity. But, undoubtedly, hospital officials will insist all the data is reliable -- perhaps that’s why they need to look over the data prior to its release.
Insurance Commissioner Releases Rates
Laura Cali, Oregon’s Insurance Commissioner, is expected to release new rates in the individual and small group marketplace on August 1 for calendar year 2015. Once that announcement has been made, the state’s health plans are expected to gear up their marketing campaigns so people can begin selecting their health plans when the insurance exchange gets underway October 1. Despite the fact that nearly 85,000 people signed up for coverage with Cover Oregon, everyone will have to re-apply to the federal exchange.
Moda Enters PEBB
Moda Health is poised to take on Providence Health Plan – starting with the state’s 53,906 public employees and their dependents for a total enrollment of 136,364. It’s entering the public sector market for the first time, hoping to snag members away from Providence next year, particularly in the Salem area where it’s launching a new product called Synergy with the backing of Salem Health. Employees will start choosing carriers on October 1 and until the end of October to make their decisions for the 2015 calendar year. Also, Moda is new to the PEBB marketplace.
Although, the Public Employees Benefit Board has already signed contracts with Moda, everyone’s waiting to see which physicians will actually be chosen for its panel, which is extremely troubling for the independent practitioners in the Salem community who’ve been ignored during the negotiations.
After this article was published, indicating that Salem Hospital was determining the provider panel and had selected Salem Clinic and its partner, Oregon Health & Science University to provide the primary and speciallty care servicesd, The Lund Report was notified by a very reliable source that Moda Health's Synergy Panel is in charge of that operation and has extended primary care participation to independent practitioners in the Salem community, while keeping a tight hold on specialists who may want to participate. .
Moda intends to release the names of its participating physicians on its own website on August 1, with periodic updates through September, according to Brian Olson, contracts coordinator for PEBB. Kaiser and Providence release similar information on their websites, Olson said.
Earlier, PEBB 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. The minuscule rate increase and wide menu of options come as a feather in the hat of Gov. John Kitzhaber as he seeks to transform the way healthcare is delivered in Oregon, according to an article that appeared in The Lund Report.
Moda is also making inroads into the Oregon Educators Benefit Board, which covers teachers and other school district employees with its Synergy and Summit health plans -- which are modeled along coordinated care lines and built on a primary care home model. These members will only see their premiums go up about 1 percent.
According to an earlier article in The Lund Report by Christopher David Gray, the Synergy and Summit plans -- which first appeared as a new option for public employees in the new Public Employees Benefit Board contract -- are not available throughout the state -- potentially because Moda has been unable to secure contracts -- and Corvallis, Roseburg and the Coast will face the brunt of OEBB’s decision.
The Summit plan uses the network built by Moda’s coordinated care organization in Eastern Oregon; Synergy has been formed as a new alliance between Salem Health, Legacy Health and Oregon Health & Science University, while expanding service in Lane County and Jackson and Josephine counties through the Asante hospital chain and Sky Lakes Medical Center in Klamath Falls.
Unanswered questions remain such as how Moda intends to reduce its costs with this new enterprise and whether hospitals and physicians are willing to accept lower reimbursement rates. It’s also unknown whether teachers who choose this option was have a more limited panel of providers in their network
OEBB had already been paying some of the highest rates in the state for hospital services through Moda, with the average hospital charging OEBB nearly three times the cost of Medicare, topping out at 411 percent of Medicare at Willamette Valley Hospital in McMinnville.
Moda, the sponsor of the Trail Blazers’ arena, may be attempting to further dump costs onto the state teacher’s benefit plan to hedge against the high rate of claims it’s undoubtedly receiving from its dominating share of the Cover Oregon market, which is much older and therefore riskier than the general population.
Deputy OEBB administrator Denise Hall told The Lund Report that her staff intends to inform teachers about the advantages of choosing the Synergy or Summit options where available. In school districts that require cost-sharing, teachers will share in the savings and only see their premiums go up 1 percent.
“The encouragement is they’ll have lower rates,” Hall said.
Diane can be reached at [email protected].
Since this article was originally published, corrections have been made about the panel of physicians eligible to participate in the Moda Health Synergy Panel for PEBB and also the article that pertains to the hospital association's releasle of its hospital profile book. The Lund Report was only given a summary document in advance of the 2013 data. We apologize for these errors.
