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Building a Healthy Oregon: Delivery System Redesign & Quality

Building a Healthy Oregon: Delivery System Redesign & Quality. Jeanene Smith MD, MPH Office for Oregon Health Policy and Research SCI Coverage Institute - July, 2009 Albuquerque, NM. Health policy reform in Oregon over the last two decades.

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Building a Healthy Oregon: Delivery System Redesign & Quality

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  1. Building a Healthy Oregon: Delivery System Redesign & Quality Jeanene Smith MD, MPH Office for Oregon Health Policy and Research SCI Coverage Institute - July, 2009 Albuquerque, NM

  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 Now - HB 2009/2116 & Oregon Health Authority

  3. 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

  4. 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 • Single state agency to act as a smart purchaser, integrator of services, and instigator of innovation

  5. Oregon Health Fund Board’s“Action Plan to Build a Healthy Oregon” • Short-term impact • Cost and quality will be compared • Local innovation will be supported • Cover 1/3 of uninsured Oregonians (approximately 15,000) • Prevention and primary care will be emphasized

  6. Oregon Health Fund Board’s“Action Plan to Build a Healthy Oregon” • Long-term impact • Reduce chronic disease, obesity, tobacco use and substance abuse • Address health care workforce • Adopt private, secure electronic medical records • Bend the health care cost curve • Provide affordable quality health care to all Oregonians

  7. Legislative Action in 2009: Companion Bills for Health Reform HB 2116 • Affordable coverage for all children • Expand OHP Standard by 35,000 • Paid for by 1% assessment on insurers, 2.8% on large hospitals HB 2009 • Creates the Oregon Health Authority, overseen by the Oregon Health Policy Board • Sets system reform in motion through key cost containment and quality measures

  8. HB 2009 – Setting Reform in Motion: Gaining Value and Cost Savings Care Coordination: • Statewide registry of physician orders for life sustaining treatment orders (POLST) • Implement uniform quality standards and payment reform, starting with primary care and chronic disease • Uniform use of Evidence-based health care guidelines and comparative effectiveness standards • Health Information Technology Oversight Council (HITOC)

  9. HB 2009 – Setting Reform in Motion: Gaining Value and Cost Savings Improved Transparency • All-claims, all payer database • Public reporting on proposed hospital and ambulatory surgical center capital projects • Healthcare workforce database and coordinated policy

  10. What were our challenges? Tough Economic Times • No extra dollars to increase primary care payments beyond current for “medical home” • No extra dollars for grants to communities to aim for “healthy communities” for those medical homes to live in • No “Quality Institute” yet, just initial steps to set standards

  11. What were our challenges? Gaining consensus • Months of discussion of the Board and it’s Delivery Committee to reach the final recommendations • New challenges arose when session began: • Legislators getting up to speed and adding their perspective • Plus the lobbyists take their turn

  12. Next Steps – Implementing a Healthy Oregon Managing Expectations: • System changes starting while also re-aligning how state govt. health functions are managed – the new “Health Authority” • Stakeholders all wanting to shape implementation to their reading of legislative language

  13. Next Steps – Implementing a Healthy Oregon Align across state entities – common work plans under new Health Authority Communicate and work with stakeholders – public process so integral to Oregon Avoid just more planning - aim to incent change in how we pay & expect from our partners to deliver quality healthcare

  14. For more information Oregon Health Fund Board materials available at: http://www.oregon.gov/OHPPR/HFB/index.shtml 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 • Email at jeanene.smith@state.or.us

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