Oregon’s Health Policy Board appears divided over whether to measure healthcare costs, following a presentation by Rachel Block, a consultant with the Milbank Memorial Fund.
“As a board, at some point we need to have the conversation about how we spend billions every year on a health system that isn’t meeting our expectations,” said Felisa Hagins, political director for the Service Employees International Union, the state’s largest union with over 50,000 members, including healthcare workers. Hagins called healthcare costs a “crisis” for consumers, pointing out that such debt is the number one cause of personal bankruptcy.
But Dr. Joe Robertson, president of Oregon Health & Science University, took a different stance. “I’m not sure I care how much the citizens of Oregon spend on healthcare,” he said. “Healthcare is one of the few industries that’s growing jobs,” and Oregon gets economic value from such spending.
But wages are being held down by healthcare costs, said Brian DeVore, a business consultant and former director of healthcare ecosystem & strategy at Intel. “Driving healthcare costs to 60 percent of GDP is not the answer,” he said.
DeVore, who resigned from the board, gave some parting advice to colleagues, saying it was time to “stab some (sacred) cows.”
“If you don’t tackle those (sacred cows), it will sink your strategy. It’s going to be uncomfortable,” DeVore said. “But ‘can’t’ and ‘won’t’ are two different answers.”
The Milbank Fund, which strives to improve population health, is working with Oregon and three other states, including Maryland, on policy efforts to limit healthcare expenditures.
“It’s a very ambitious program,” Block said of Maryland’s monthly or real-time data collection. Now Maryland is moving to collect all-system spending, including physician data as well as hospital costs.
Leslie Clement, chief of policy for the Oregon Health Authority, suggested that member experience, from enrollment to access to care be measured because the Centers for Medicaid and Medicare Services is paying attention to that.
The first task, she said, is to collect accurate, reliable data, then move to accountability, citing the cost of pharmaceuticals as one area “really needing policy decisions.”
OHSU’s Robertson said the integration of behavioral and dental health into Oregon’s health transformation has been so far a “miserable failure” and he plans to be “relentless about pursing” metrics on oral health.
Carlos Crespo, a board member and professor and director of the School of Community Health at Portland State University, hoped the data would be less reliant on self-reporting to include “robust public health” data “on more than what’s collected in a healthcare setting.” He also pointed out that CCOs were supposed to improve the health of the community so one of the metrics should measure benefits to everybody, not just Medicaid patients.
DeVore suggested data experts from the financial services world might be helpful and he called for leveraging the relationship with the nonprofit Oregon Health Care Quality Corporation more.
“The crisis in healthcare costs is at the forefront of consumers’ minds,” said Jesse O’Brien, a healthcare advocate for the consumer group OSPRIG during the public comment period.” If not the OHPB, who should lead this critical conversation?”
Jan can be reached at [email protected]
