The jugglers on the Oregon Health Policy Board kept their balls in the air on Tuesday as they explored a raft of issues facing the state: expanding and supporting the healthcare workforce; making Medicaid more effective through the push for CCO 2.0; and understanding and addressing opioid addiction. They also tabled one major concern temporarily: pharmaceutical costs.
Policy board Chairman Zeke Smith said it does not make sense for the board’s pharmacy committee to do work that might overlap with a legislative committee created during the most recent session. House Bill 4005, which passed in March, requires drug companies to explain certain price hikes and establishes a legislative task force to examine the many factors – including middlemen benefit managers – that may drive up prices. The task for is due to report its findings this November.
Oregon Health Authority staff will continue analyzing pharmacy costs and transparency, and the health policy board will re-engage with pharmaceutical costs after the legislative task force completes its work, Smith said.
Until then, the policy board still has plenty to tackle.
Workforce Update
In 2017, the Legislature passed House Bill 3261 to consolidate multiple Oregon healthcare workforce efforts into a single program, create new programs to train and support the workforce, and track how well these efforts are working. As experts testified at an Oregon Health Forum conversation in March, the state faces a number of challenges, including training the right professionals for the needs of the state, recruiting workers to rural areas, and boosting retention.
The Oregon Health Policy Board is guiding the health authority’s efforts through its workforce committee, which presented a status update Tuesday.
Joe Sullivan, healthcare provider incentives coordinator for the Oregon Health Authority, said that 12 people were awarded funding through the state’s loan forgiveness program, with $525,000 going to nine physician assistants, one MD and one DO doctor. Applications are open through May 11 for providers in certain in-demand specialties to apply for the next round of repayment incentives.
Sullivan noted that state and federal incentives available to Oregon providers in the 2017 to 2019 period include $16.2 million in tax credits for rural practitioners and volunteer EMTs, $9 million in loans grands and subsidies, $4.3 million in loan repayment, and $7.1 million in scholarships and loan forgiveness programs.
The Oregon Health Policy Board next aims to develop parameters for loans and grants to communities across the state, with a goal of supporting new professional training programs, and identifying other ways to support local workforce needs. Meanwhile, staff are working to develop the evaluation of workforce programs they must deliver to the legislature by this fall.
CCO 2.0
Healthcare leaders are in the first stage of preparing for what they are calling CCO 2.0 – an effort to take a bold, evidence-driven look at coordinated care organizations, ahead of the the five-year Medicaid contracts that begin in 2020.
Phase I of this effort, expected to last through June, is focused on drafting policy recommendations with a heavy focus on gathering feedback from across the state, Steph Jarem, operations and policy analyst with the Oregon Health Authority, told the policy board on Tuesday.
An online survey is gathering comments with a heavy focus on provider and industry insight, and will close April 15. Another survey is in the works that will focus more on the public’s experience of CCOs to gain less technical feedback, said Jeremy Vandehey, head of the health authority’s Health Policy and Analytics Division.
“When we are done with this, this needs to have resulted in actual engagement,” health authority Director Pat Allen said, noting that an unsuccessful process would be one in which people feel they did not have an opportunity to engage until after policy has been drafted or set in stone.
With that emphasis on hearing from Oregonians, the health authority this week announced plans to hold three public discussions on the CCO 2.0 process, upcoming on April 20, 21 and 28.
“There’s an opportunity to provide general input now, and there will also be opportunity to provide input through subcommittees, so if somebody is really knowledgeable about health equity, for example, now is the time to get to the health equity committee,” said policy board chairman Smith.
Phase 2 of the CCO 2.0 effort will launch in June, when the Oregon Health Authority plans to stage a “road show,” giving presentations and seeking public input on draft policy recommendations that emerge from the first phase of this effort. The agency aims to develop final policy recommendations and a draft report for CCO 2.0 by September.
The third and final phase outlined by Jarem is what she called “operationalization” – completing a final report, identifying which recommendations might require changes by the legislature, and outlining system goals and a five-year plan.
Opioids: Strategies for Prescribers
Oregon’s record on prescription opiates shows there’s significant room for improvement, state epidemiologist Dr. Katrina Hedberg told the health policy board.
The state consistently ranks in the top 10 in the U.S. for non-medical use of opioids – for example, when pills left over from an old prescription are later used for another use. “You want to be at the very bottom of this list, not in the top 10,” Hedberg said at the opening of her presentation – which specifically focused on prescription medications, not non-prescription opioids like heroin and illegally manufactured fentanyl.
“Our heroin use rate has been relatively flat,” Hedberg said. But across the U.S., “illnesses of despair have been increasing.” Suicides, liver disease (often linked to alcohol) and drug overdose are climbing as causes of death.
Since 2000, more Oregonians have died of drug overdoses linked to pharmaceutical and synthetic opioids than of heroin overdose. “The good news is that we are one of the states that has started to see a decline in drug overdose deaths,” which are down about 17 percent, she said.
But to continue that decline, the state has work to do, she said.
Oregon’s prescription drug monitoring program is gradually expanding, but its effectiveness still lags many other states, Hedberg said. Starting July 1 all providers will need to be registered with the PDMP program, but they will not be required to check patient histories in the database before prescribing opiates – something some states do require.
A new clinical review subcommittee will discuss how to identify so-called “pill mills,” but there’s still much work to do in this arena. Today, most investigations are led by the FBI or state law enforcement. The Oregon Health Authority does not report concerning prescription data to the medical board or law enforcement – and may be prohibited from sharing this information by statute.
Policy changes from the legislature could improve the state’s efforts to limit opioid prescriptions – but until then, the health authority is doing what it can, she said.
Hedberg outlined four goals the state has been working towards since 2015, with the ultimate aim of reducing deaths, non-fatal overdoses and other harms:
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Make pain treatment safer and more effective with an emphasis on non-opioid treatments.
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Reducing harm experienced by people taking opioids by expanding access to naloxone, used to treat overdoses, and supporting recovery programs.
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Reducing the number of pills in circulation.
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Gathering data and making it available to track progress and improve these efforts.
“A lot of work has gone on around improving non-opioid treatment and reducing harms,” she said. “A lot of this work still needs to be implemented at the local level.”
Reach Courtney Sherwood at [email protected].
