Policy Board to Put Forward Tool to Encourage Team-Based Care

The Health Policy Board has been without a quorum since October so it couldn’t take any action Tuesday, but it has several ideas that are ready to put before the Legislature.

The Oregon Health Policy Board appears poised to recommend a series of small, incremental reform bills to the Legislature, if only the board could get a quorum of its members to show up for its meetings.

For the second straight month, the policy board failed to get a quorum and couldn’t even approve the minutes of past meetings, let alone take action on legislative priorities. The board is not scheduled to meet again until January but Chairman Zeke Smith hinted that he would try to call the board together before the end of the year so it can take care of its business.

The first piece of legislation would set up a “multi-payer collaborative,” which would require all major insurance companies regulated by the Oregon Insurance Division to set up uniform methods for alternative billing that will help the state get beyond paying doctors and hospitals based on the number of procedures they perform.

Smith relayed a message from Dr. Carla McKelvey, the vice-chairman of the board, who could not attend: “Her interest was in really getting to an alternative payment standard as soon as possible so these providers don’t fall of the cliff,” he said. Clearing up the uncertainty in how the payment structure will work should help ensure that primary care providers will be able to adequately plan for a shift in payment.

Nicole Merrithew at the health authority reiterated that joining the collaborative will be a requirement of insurers, creating a place where they can all be on the same page about reforms -- which will be particularly important in a health insurance market as fragmented as Oregon’s, where the market is divided between seven major health insurance companies, plus a handful of smaller players and two consumer run insurance companies.

Reaching an agreement among insurers is also critical to ensuring that Gov. Kitzhaber’s desire to expand coordinated team-based care can move beyond Medicaid and into the larger commercial health insurance market without stalling.

For physicians to make the leap from billing for procedures to providing wrap-around care and other whole-health services, they’ll need to be ensured that insurers will present them with a simple contract to pay for such services, which is the direction the Oregon Health Plan has taken.

Other legislation would permit the Oregon Health Authority to provide information technology consultation to facilities and physician’s offices and charge fees.

An additional recommendation may not require legislation, asking that the Oregon Health Authority monitor the emergency department information exchange, to help develop reports of people showing up frequently at different hospital emergency rooms, either because they struggle to access primary care or are using the ERs to get multiple drug prescriptions.

Susan Otter, the director of health information technology at the health authority, said that Washington state identified $33 million in direct savings by improving awareness of how emergency departments are being used.  

Board member Felisa Hagins of the Service Employees International Union Local 49 added that many cost savings wouldn’t even be tracked. And, if people in a midst of a mental crisis are steered toward appropriate services, it would mean better care for them, and a safer environment for other patients and employees.

“I’ve seen it work in Washington, and it’s definitely made our workers safer,” Hagins said.

A separate work group, which took up the governor’s challenge to set a sustainable rate of growth for healthcare spending, finished the year without any hard recommendations to put before the 2015 Legislature.

Using data from the all-payer, all-claims database, and the state Medicaid program, Oregon Health & Science University economist John McConnell was able to track $7.1 billion in healthcare spending in Oregon for 2012. But using looser estimates that include Medicare, Veteran’s Affairs and spending by the uninsured, he estimated that actual spending that year was closer to $14.1 billion.

Despite not getting close to making a recommendation to the Legislature on what a sustainable rate of growth might be, Jesse Ellis O’Brien of the Oregon State Public Interest Research Group, who sat on the workgroup, hopes the policy board forms a new workgroup in the coming year to continue working on this issue at the policy board level.

Chris can be reached at [email protected].

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