1. Oregon Health Plan:
Twenty Year Reform Journey from
“The List” to CCO’s
Glenn S. Rodriguez, MD
glenn.rodriguez@providence.org
November 5, 2011

2. Health policy reform in Oregon
over the last two decades
 1980’s - Pre-Oregon Health Plan: early
pioneers in managed care in selected cities
 1994 - Oregon Health Plan: Prioritized List,
hi-risk pool, created a policy office, aimed for
an employer mandate
 2003 - OHP2: reform efforts thwarted with
budget cuts due to recession
 2007 - Oregon Health Fund Board: statewide
health reform planning process
 2009 - HB 2009/2116 & Oregon Health
Authority
2

3. Original Goals of the
Oregon Health Plan
 Health care for the uninsured
 Basic benefit package of effective services
 Broad participation by providers
 Decrease cost shifting & charity care
 A rational way to allocate resources for
health care
3

4. 2003 Recession impacts OHP2
 Oregon continues to struggle with highest
unemployment in the country as OHP2
changes are implemented
 Funding cut for adult expansion population
(OHP Standard):
◦ Results in deeper benefit cuts
◦ Loss of coverage for ~80,000 adults on OHP
Standard
◦ 24,000 adults maintained by taxes on hospitals
and managed care plans
4

5. As Oregon’s Economy Recovered, New
Reform Energy Emerges
 Multiple healthcare ballot initiatives & efforts to
gain public input to outline priorities
 Governor’s HealthyKids initiative
 Re-focused look at prevention and chronic
diseases via the Prioritized List
 Health reform plan development
◦ Oregon Health Policy Commission
◦ Senate Interim and 2007 Session Committees
◦ Oregon Business Council & Archimedes
 Culminated in the creation of the Oregon Health
Fund Board (SB 329) by the 2007 Legislature5

6. Oregon Health Fund Board, 2007-08
 7 member citizen board
 Six committees
◦ Benefits, Eligibility and Enrollment, Finance, Health
Equity, Delivery Systems, Federal Laws
 Two workgroups
◦ Health Insurance Exchange, Quality Institute
 Over 110 public meetings with 20 town hall
meetings across state
 Over 1,500 comments received through
meetings and written comments

7. Oregon Health Fund Board’s
“Action Plan to Build a Healthy Oregon”
 Two track approach:
◦ Expand Coverage
◦ Contain Costs and Improve Quality
 Keystone: Oregon Health Authority & Health
Policy Board
◦ Single state agency to act as a smart purchaser,
integrator of services, and instigator of innovation
◦ Citizen-led Board provides direction and
accountability
◦ Represents over 850,000 people, or over 25% of
the health care market in Oregon
7

8. HB 2009 – Setting Reform in Motion:
Streamlines State Health Functions
Oregon Health Authority
 Consolidates state health purchasing and aligns
programs to maximize efficiencies
 Public Employers Benefits/Oregon Educators
 Medicaid
 High Risk Pool and Premium subsidy (FHIAP)
 Public Health
 Mental Health and Addictions
Oregon Health Policy Board
 Guides the Health Authority as it implements
reforms to gain value and reduce costs

9. The Three Goals of
The Oregon Health Authority
 Improve the lifelong health of Oregonians;
 Increase the quality, reliability and
availability of care for all Oregonians; and
 Lower or contain the cost of care so it is
affordable to everyone.

10. Primary Care as the Foundation for
Healthy System Reform
 Patient Centered Primary Care Home
Standards Work Group
◦ Dr. Rob Stenger, former AAFP resident Board
member, lead staff from OHPR
 Six core attributes
 Patient centered language
 Measures and tiers
 Attestation, data submission, recognition

11. Attributes
 Access to Care
◦ “Health care team, be there when we need you”
 Accountability
◦ “Take responsibility for making sure we receive the best possible
health care”
 Comprehensive Whole Person Care
◦ “Provide or help us get the health care, information, and services
we need”
 Continuity
◦ “Be our partner over time in caring for us”
 Coordination and Integration
◦ “Help us navigate the health care system to get the care we need in
a safe and timely way”
 Person and Family Centered Care
◦ “Recognize that we are the most important part of the care team –
and that we are ultimately responsible for our overall health and
wellness”

12. Measures Example: Continuity
 Must – Pass
◦ Active patients assigned to clinician or team
◦ Measure % visits with assigned clinician/team
◦ Comprehensive health record
◦ Provides hospital care or written agreement with
hospital providers
 Tier 2
◦ Demonstrates improvement in continuity
measures
 Tier 3
◦ Performance exceeds benchmark

13. Data Requirements
 Initial data requirements
◦ Satisfaction survey
◦ Percentage of active patients with assigned
clinician/team
◦ Percentage of visits with assigned clinician/team
◦ Annual experience of care survey on all six
attributes (CAHPS tools recommended)
◦ Results on 2 quality measures from approved list
(30 options)

14. The New Vision:
Coordinated Care Organizations
 Guided by the OHPB triple aim goals, CCO’s will be the primary
agent for health system transformation
 New regional community based organizations
◦ “Next generation of Oregon managed care organizations”
 Integration of physical, mental and oral health
◦ “Break down barriers between silos of care: especially
medical, mental health and long term care”
 Global risk for cost of care
◦ “Expectation of new payment methodologies with immediate
savings (already in state budget)”
 Summary and FAQ at:
http://health.oregon.gov/OHA/OHPB/health-reform/docs/cco-faq.pdf

15. Timeline
 Oregon Health Policy Board CCO Work
Groups recommendation due Dec. 1, 2011
◦ CCO criteria and governance
◦ Global budget methodology
◦ Medicare / Medicaid integration
◦ Outcomes, quality and efficiency metrics
 Recommendations to Legislature for Feb,
2012 session
 Implementation goal: July, 2012

16. Progress to Date:
 Healthy Kids – 57,000 enrolled
 End of Life care: POLST registry operational –25,000
enrolled
 Administrative Simplification Standards passed; to come to
2011 Legislature
 Strategic planning for health information exchange
 Implementing primary care medical homes
 Payment reforms and quality standards being developed
 Plan for health insurance exchange to go to legislature in
January
 Held 6 community meetings around Oregon to gain input
on exchange
 Oregon Health Study on the impact of being uninsured in
America

17. For more information
 Oregon Health Fund Board materials
available at:
http://www.oregon.gov/OHPPR/HFB/index.html
 HB 2116 & HB 2009 available at:
http://www.leg.state.or.us/09reg
 Oregon Health Policy & Research
◦ Website: www.oregon.gov/ohpr
◦ Call us at 503-373-1779

18. HB 2116 – Expanding Coverage