Before the pandemic, the Oregon Health Authority and the industry grappled with how to rein in soaring health care costs, increase access to more Oregonians, diminish inequities and make the health system more accountable.
Those needs have not disappeared. But the pandemic has added other challenges: stemming the spread of the virus and plunging revenues.
The Oregon Health Policy Board, which guides state action, discussed this new normal on Tuesday in a meeting that included health care advocates and industry experts who considered ideas about how to accomplish all these tasks simultaneously.
“We know that we’re going to be weathering the storm for quite some time,” said Jeremy Vandehey, policy and analytics director at the authority.
The board recognised that Oregon needs to build a health care system that puts equity first and looks for ways to incorporate lessons learned during the pandemic, such as the need for wider use of telehealth, while coming to terms with the fact that the state will have fewer resources in the future. Economists say it will take Oregon years to emerge from the recession.
“We’ve got to accept that there’s no old system to go back to,” Vandehey said during an overview of how the health care industry fared after the state halted elective procedures when the pandemic started in March.
Gov. Kate Brown allowed those procedures to resume in May with certain restrictions. Doctors have to maintain an adequate stock of personal protective equipment and take steps to limit patient numbers to ensure people are not crowded in waiting rooms, for example.
That suspension of elective procedures affected many providers, Vandehey said, with some seeing an 80% drop in revenue through May. Some providers and clinics have almost returned to normal, but he said “major parts of the system are still feeling disrupted.”
Individual providers often have less of a financial cushion than larger operations. About one-quarter of primary care providers reported they had enough financial reserves to cover their expenses only for three months or less, according to a May survey. That compares with millions or even billions of dollars that large hospital systems like Providence Health System or even Oregon Health & Science University have tucked away.
James Schroeder, chief executive officer of HealthShare of Oregon, the coordinated care organization for Medicaid members in the Portland area, warned that many clinics are walking a financial tightrope.
“We need to be planning now (in case) there is another shutdown,” Schroeder said.
He said a lot of providers do not rely on Medicaid reimbursements to survive but still need to be included in discussions if another shutdown hits the health care industry.
Another coordinated care organization echoed his concerns.
“There’s no normal to return to for our health care system,” said Carrie Prechtel, community engagement manager with Grants Pass-based AllCare Health, a Medicaid insurer with members in Josephine, Jackson and Curry counties.
She urged the state to remain flexible and give insurers the ability to make decisions locally. As an example, representatives from coordinated care organizations said they were grateful that the state was giving them more time to file reports.
The board also heard from Oregon Health Authority Director Patrick Allen, who said the state still has work ahead in moving forward the aims of the so-called CCO 2.0 initiative, which is intended to increase accountability for coordinated care organizations.
“We’re all operating in sort of a crisis mode, and so how do we continue to advance what we want to advance,” he said, adding that there’s some “pushback and friction” in the effort to increase accountability.
Allen said the authority is working on developing a COVID-19 recovery unit that handles the “lion’s share” of work tied to the pandemic. That is intended to help the authority continue its work in other areas that started before the pandemic.
Another way the state has adjusted to the new normal is its shakeup of the quality incentive program, which has awarded coordinated care organizations for hitting benchmarks. Since 2013, when it was created, the program has provided coordinated care organizations up to $188 million annually for meeting certain health metrics like achieving certain vaccination rates for children, screening for depression and providing treatment for behavioral health issues.
This year, the committee that oversees the program decided that CCOs would only have to report metrics but not achieve any targets. In 2021, all 13 existing metrics will continue, plus there will be a new metric on health equity. The authority recommends that the targets in 2021 be based on 2019 data because in 2020, “things have fallen off the cliff,” said Stacey Schubert, director of health analytics for the authority.
The board also discussed the need for equitable health care among communities of color, an issue that’s been highlighted by the pandemic with COVID-19 affecting a disproportionate number of Blacks, Latinos, Native Americans and Pacific Islanders.
Advocates urged policymakers to adopt a unified strategy moving forward.
“What we’re really lacking is a strategy from OHA that is a public health strategy,” said Serena Cruz, executive director of the foundation for the Virginia Garcia Memorial Health Center, which has clinics in Washington and Yamhill counties and serves many low-income patients. “You are the public health experts, and we need that strategy to be focused.”
Latinos represent 37% of COVID-19 cases but just 13% of the population in Oregon. Yet stemming those cases will not be easy. Many Latinos work in agriculture, health care and food service, sectors with limited opportunities to work from home. Also, undocumented workers in these sectors are reluctant to share information with contact tracers trying to identify people who might have been exposed to the novel coronavirus out of fears that they’ll be reported to immigration authorities.
Olivia Quiroz, executive director of the Oregon Latino Health Coalition, said there is “fear and anxiety” in the community that comes from a combination of low wages, uninsured families and lost jobs.
The overall economic picture is grim. The state faces a $2.7 billion revenue shortfall for the rest of this fiscal year. The 2021-2023 biennium has a projected $4.4 billion biennium.
The Legislature will have a special session starting Monday to balance the budget shortfall and cuts are expected. Vandehey said the bigger concerns lie ahead during the next budget cycle.
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.
