Transformation Team Concludes Work, Passes Torch To Legislature

But concerns remain about costs, community impacts, and federal cooperation

March 24, 2011--The Health System Transformation Team concluded its work Wednesday night, and passed the torch to the Legislature with a mixture of celebration, caution and concern about the costs and cooperation needed locally and federally to implement healthcare reform.

“Your work product exceeded my expectations on a number of levels,” Governor John Kitzhaber told the team.
He praised team-produced documents detailing the timeline for the transformation process and the definition and scope of the “Coordinated Care Organizations” (CCOs) that will integrate physical, oral and mental health services for Oregon Health Plan members and the dual eligible – people who receive both Medicaid and Medicare Services. Those CCOs will operate within a global budget.
That concept, in which the state would pay a CCO a fixed amount of money for providing its members with “the full continuum of services,” represents a dramatic shift from the current healthcare system’s capitation model and focus on fee-for-service billing.
The team’s proposed changes will require a number of federal waivers including its proposals to blend Medicare and Medicaid funding for the dual eligibles; creating a global budget; mandating enrollment in CCOs for a specified length of time; and allowing CCOs to share patient information “for the purposes of care coordination and treatment.”
“I will work hard with our federal partners to gain the flexibility we need, and help the Legislature to whatever extent would be useful,” said Kitzhaber.
The state would like to submit these waiver requests by July 1, assuming the Legislature approves the proposals.
On Monday, a joint legislative committee will be announced whose members will shape the bill with input from stakeholders.
Lawmakers will have to change state statues around payment methodologies and patient information sharing, and create new rules requiring measures of health outcomes and quality of care, according to Linda Grimms, legislative legal counsel.
“We’ll have to be creative about ensuring we have flexibility in statute,” said Dr. Bruce Goldberg, the Oregon Health Authority director and Transformation Team co-chair. “We may have to make changes next session as well” before implementing changes statewide by July 2012. The Legislature will convene again next February.
Health Authority staff took a stab at estimating savings for the 2011-13 biennium based on cost-cutting ideas proposed at the team’s first meeting February 2, including restructuring dental benefits and eliminating payments for currently covered treatments on the Oregon Health Plan’s prioritized list that “have been determined by evidence to be marginally effective.”
The net savings estimate of the proposed changes, not including what’s already in the governor’s balanced budget, is $34 million.
But some team members questioned those estimations. “Having served on the primary care medical home task force, I know that there’s no indication from that group that there will be any savings there,” said Dr. Bob Dannenhoffer, CEO of DCIPA, an Oregon Health Plan. “Yet here I see a decrease of over $10 million” if primary medical homes are implemented.
Those estimates were “primarily designed to be a benchmark,” responded Dr. Jeannine Smith, administrator of the Office for Health Policy and Research, and were based on national studies that predicted potential savings through using the primary care medical home model.
Those tasked with making the laws provided a political reality check.
“We’ve got a 30-30 split in the House, and a Senate with its own idiosyncrasies,” said Rep. Mitch Greenlick (D-Portland), who announced he’d be serving on the joint legislative committee that would put the final touches on the bill. “We’ve got to make sure this is something that’s acceptable with Republican and Democratic caucuses.”
“I see a huge disconnect between what we’re talking about [here] and what’s happening at the community level,” said Sen. Alan Bates (D-Medford), a practicing physician who influenced the creation of the Transformation Team. “To change attitudes around how people practice is going to be a leap, and [making] that leap will require specific things in the bill itself.
“If we don’t do that,” he added, “we don’t transform healthcare.”
 Rep. Bill Kennemer (R-Oregon City) urged his colleagues to proceed with caution.
“Government and large systems change slowly and with great difficulty,” said Kennemer. “And the unintended consequences combined with the smart people involved in healthcare makes it very dangerous work.”
Rep. Tina Kotek (D-Portland) took a different tack.
“I’m not worried about the risk,” said Kotek. “The time is now. Let’s hold hands and jump off the cliff together.” 


 Prior coverage of the Health System Transformation Team here.
All Transformation Team documents, including the team’s original charter and updated timeline, available here.


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I was told as a young child if your friend jumped off a cliff would you do it too? Nice to see Tina is now encouragin such behavior.

Individuals named Anonymous are all over the Lund site. Why? Be proud of yourself for opposing health care for all Oregonians. Be proud as you pray that we fail, and that our representatives be unable to design a solution to punishing health insurance costs. Be proud of the work you do and the opinions you share. Viva Brian Owendoff!

HB 3510 - the Affordable Health Care for All Oregon Act meets and exceeds the stated goals of the Transformation Team - the Triple Aim - but has been ignored in the discussions apparently since it eliminates the for-profit insurance industry from the equation. Vermont and 18 other states in addition to Oregon are considering similar legislation to bring universal coverage, single risk pool financing, net job creation, cost containment and improved health care outcomes to their citizens. Why was this not seriously considered by the OHSTT? There are plenty of advocates of single payer health care available in Oregon to give testimony as happened on March 11, 2011 in Salem at the House Health Care Committee.