Oregon has a long history of working to address healthcare value and curb high healthcare costs. The state has enacted legislation creating the Oregon Health Care Cost Growth Benchmark Program, which sets a state spending growth target for all insurance companies, hospitals and healthcare providers. Additionally, under the Oregon Prescription Drug Price Transparency Program, drug companies are required to publicly disclose reasons for steep drug price increases to the Department of Consumer and Business Services. The hope is that transparency efforts will help legislators make informed decisions on how to control drug prices.
Oregon uses an All-Payer Claims Database (APCD) to track healthcare costs, quality and utilization to further improve the transparency of health spending in the state. Their APCD collects information on medical claims, eligibility, alternative payment methods and pharmacy spending from commercial insurers and public payers.
Oregon ranks among the best for avoidable hospital use and cost, according to the Commonwealth Fund’s Scorecard on Health System Performance. Like most state, Oregon should consider additional steps to improve affordability for residents, such as surprise medical bill protections and protecting consumers from short-term, skimpy plan designs.
Oregon lawmakers passed legislation that will require healthcare providers to be reimbursed at the same rate for telehealth services as in-person services, according to the Lund Report. The law, HB 2508, comes during the coronavirus pandemic, when use of telehealth services increased significantly.
Health insurers in Oregon that waived all deductibles, copayments and other costs for insured patients who fell ill with COVID-19 and needed hospital care, doctor visits, medications or other treatment are no longer waiving fees for COVID treatment, according to The Lund Report. In a study released in November, researchers found about 88 percent of people covered by insurance plans — those bought by individuals and some group plans offered by employers — had policies that waived such payments at some point during the pandemic. Waivers resulted in significant savings for COVID patients who fell seriously ill and wound up in the hospital.
The Oregon Health Authority (OHA), along with the Oregon Health Leadership Council, announced that 40 organizations have signed a compact to adopt “value-based payments” which reward healthcare quality rather than healthcare quantity, according to OHA. The agreement targets moving to 70 percent of payments following advanced value-based payment methods over five years and supports the work of the cost growth target program, which is beginning implementation this year. In Oregon’s healthcare transformation efforts, value-based payments are one of a few key tools to achieve meaningful cost containment while prioritizing quality care.
The Oregon Health Authority has officially launched the Community Benefit Minimum Spending Floor program—a regulatory system intended to ensure that Oregon’s nonprofit hospitals don’t cut their spending on charity care, according to The Lund Report. Other states, especially those that expanded Medicaid, have taken similar steps to ensure that nonprofit hospital systems devote an adequate portion of their spending to community-benefit programs. The Oregon Health Authority’s definition of community benefit not only includes charity care to uninsured or indigent people, but also community health programs, employee education, certain kinds of research and the difference between what a hospital says it costs to care for a Medicaid-covered patient and the amount that the state pays as reimbursement.
Oregon’s healthcare workforce does not match the diversity of the state, according to the Oregon Health Authority’s (OHA) biennial Oregon Health Care Workforce Needs Assessment report, which shows that the Hispanic/Latino, African American/Black, and American Indian/Alaska Native providers are underrepresented in most licensed healthcare professions. OHA also released its evaluation of the Health Care Provider Incentive Program, which is designed to increase racial and ethnic diversity in the healthcare workforce.
Oregon health officials and lawmakers are seeking the legislature's approval on formal report describing a cost-growth-capping program that would hold insurers and large and medium-sized medical practices to annual per-patient cost growth caps, require formal justification if they exceed the cap, and potentially fine them if they exceed the cap, according to The Lund Report. Oregon would be the fifth state to adopt a cost growth target program. The Sustainable Health Care Cost Growth Target Implementation Committee hopes to address the root causes of healthcare cost growth, however, there is worry that some providers and insurers, anxious to come in under the cap, may try to cut the quality or volume of care.
Prenatal care utilization and health outcomes for newborns have improved in Oregon in the three-year period following the state’s Medicaid expansion in 2014, according to two studies from Oregon State University featured in Health Affairs. Medicaid expansion was associated with a 2 percent increase in first trimester prenatal care utilization, a 23 percent reduction in preterm births and a 29 percent reduction in low birthweight among babies born to women covered by Medicaid.
Oregon has had a longstanding focus on health equity and employed two foundational strategies that can serve as examples for other states seeking to further their health equity efforts, according to State Health & Value Strategies. The state has been very intentional with language used to describe equity efforts, how key terms are defined and has placed an emphasis on engaging community partners to ensure that the community voice is apparent in state-level policy decisions. The state also developed a framework to demonstrate the importance of moving upstream to the understanding that racism, discrimination and bias impact the health outcomes of people who have been subjected to long-standing, even centuries-old oppression. The development of common definitions and adoption of a framework for understanding where work needs to focus has allowed for robust internal and external coordination and impact around how to work towards achieving health equity.
Cancer and rheumatoid arthritis brand-name drugs continue to be the most expensive for Oregon residents, according to new data from the Oregon Division of Financial Regulation. For the second year in a row, the brand-name drug Humira, commonly used to treat rheumatoid arthritis, was the costliest prescription drug reported by Oregon’s health insurance companies, as well as the most prescribed specialty drug. Glatiramer, used to treat multiple sclerosis, was the most expensive generic drug reported, costing insurance companies approximately $2,800 per prescription. To determine what insurers paid on average for each prescription and to identify the most expensive prescriptions, the program team examined claims data for drugs prescribed to 10 or more enrollees and compared the total dollars spent by insurers to the corresponding prescription counts for each drug.
The Oregon Health Authority released the 2019 CCO Metrics Report, which shares the results of Oregon’s pay-for-performance quality incentive program for its coordinated care organizations (CCOs). This report shows CCO performance across three categories of measures: CCO incentive metrics, state quality metrics and CMS core metrics. For example, in 2019, nine of 15 CCOs improved on the use of emergency departments among members with mental illness. However, asthma as a cause of hospital stay increased almost 12 percent at the statewide level in 2019.
A study to understand perceptions of how medical students and institutions can meet the needs of the self-identified houseless community found that people who are houseless want medical students to 1) listen to and believe them, 2) work to destigmatize houselessness, 3) engage in diverse clinical experiences, and 4) advocate for change at the institutional level, according to the Social Interventions Research & Evaluation Network at the University of California, San Francisco. Authors concluded that medical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems and institutions should change their approaches to healthcare delivery and advocacy.
State regulators are expected to start combing through the finances of thousands of Oregon medical practices with a goal of capping per-patient spending growth at 3.4 percent, according to the Lund Report. The state’s Sustainable Health Care Cost Growth Target Implementation Committee has been working to craft a workable plan to slow the increase in healthcare spending. The committee is using a collaborative approach to cap rates, but committee members and Oregon Health Authority staff have not yet decided which entities will be subject to agency scrutiny and enforcement. Hospitals and major practices will likely be on the list, but the inclusion of large specialty clinics and small medical practices is still up for debate.
A 2013 payment reform implemented by Oregon’s Medicaid program was associated with a 42.4 percent relative reduction in traditional primary care services—driven primarily by decreased use of imaging services, according to Health Affairs. The payment reform changed the Medicaid program’s reimbursement of traditional primary care services for selected community health centers (CHCs) from a per visit to a per patient rate. The authors stated that Oregon’s initiative could provide lessons for other states interested in using payment reform to advance the patient-centered medical home model for the Medicaid population.
An analysis performed by the Oregon Health Authority and the Oregon Health Leadership Council showed that 40 percent of evaluated services were found to be low-value and constituted more than $500 million in spending, according to a new report. Researchers reported that Medicare had the highest rate of low-value services per 1,000 members at 595.5, which is approximately 170 percent higher than the rate for the commercially insured population. The report examines 47 measures and includes actionable opportunities to address the rise in healthcare costs and improve the effectiveness of care that is delivered to patients in Oregon.
Oregon legislators have released a new framework, developed by the Office of Diversity, Equity, and Inclusion, to help state agencies increase attention on equity and racial justice in response to the COVID-19 pandemic, according to My Oregon News. COVID has surfaced long-standing health inequities that have caused higher rates of chronic health problems within communities of color compared to white communities. The core elements of the framework include a commitment to: using inclusive communications; forming community-informed policy and partnerships; ensuring safety for communities by protecting against discrimination, racism, xenophobia, violence and hate crimes; collecting, analyzing and reporting data in a culturally- and linguistically-responsive way; and making investments in community resilience
Oregon state officials have requested a Medicaid waiver to delay all income verifications until after the state of emergency in response to COVID-19 is lifted, according to The Lund Report. Legislators are also considering options that would enact a grace period for non-payment of insurance premiums that lasts for the duration of the emergency declaration and put an “any willing provider” provision in place to eliminate out-of-network status for patients.
The Oregon Sustainable Health Care Cost Growth Target Committee, assigned to set a statewide cap on the rise in healthcare spending, has agreed to a growth cap of 3.4 percent per year, according to the Lund Report. Committee members still have to decide how to measure quality and equity, ensure that the program is transparent and that the industry is held accountable. State advocates also asked the committee to prioritize affordability for consumers.
As part of its 2012 Medicaid waiver, Oregon created 16 coordinated care organizations (CCOs) to manage care for Medicaid recipients with the ability to use “flexible services” to reduce the need for medical services--defined as low-cost, health-related services not covered by the state’s Medicaid program. A recent study in the Journal of Health Politics, Policy and Law looked at the use of these services and the challenges providers faced. A key finding was the need to provide managed care organizations (MCOs), such as CCOs, with detailed definitions and guidance up-front on health-related services they are expected to coordinate and pay for. While flexibility to pay for a variety of services may help MCOs respond to their patients’ unique health-related needs, many CCO informants described clarification and certainty provided by new rules as helpful.
As health plans prepare to submit rate filings, a new report from Oregon’s Division of Financial Regulation’s Prescription Drug Price Transparency Program illuminates just how much prescription drug prices impact insurance premiums. Oregon requires health plans to report on: per member, per month (PMPM) drug costs; top 25 drugs responsible for the greatest increase in planning spending; top 25 most costly prescription drugs; and the top 25 most frequently prescribed medications. Based on 2018 data, on average, drug costs represented 14 percent of premium rates in Oregon. Abbvie’s Humira, a biologic used to treat various autoimmune diseases, topped the list as both the most costly and the largest contributor to increases in plan spending.
Oregon has passed legislation creating the Oregon Health Care Cost Growth Benchmark Program, which will set a state spending growth target that all insurance companies, hospitals and healthcare providers would have to stay within, according to The Lund Report. Oregon is the fourth state to set a spending benchmark intended to rein in the rising cost of healthcare. In Massachusetts, the policy saved $5.5 billion for consumers between 2013 and 2016. Currently, Oregon has the third highest health insurance deductibles in the country and is in the top 10 highest states for family budgets spent on out-of-pocket hospital costs.
Healthcare organizations across the U.S. are developing new approaches to address patients’ social needs. Medicaid programs are uniquely placed to support these activities, given their central role in supporting low-income Americans, yet little evidence is available to guide Medicaid initiatives in this area. A study in Health Affairs examined how Medicaid funding was used to support social interventions in sites involved in California and Oregon’s payment reforms. Investments were made in direct services—including care coordination, housing services, food insecurity programs and legal supports—as well as capacity-building programs for healthcare and community-based organizations. Several factors influenced program implementation, including the local health system context and wider community factors. These findings offer insights to healthcare leaders and policymakers as they develop new approaches to improve population health.
Legislators in Oregon have called for the development of plan to achieve a “predictable and sustainable” annual growth rate for statewide healthcare spending, according to Milbank Memorial Fund. The plan would be developed by a public-private advisory group and implemented, at least initially, by the Oregon Health Authority within existing laws. Enforceable limits on cost growth will take effect in 2022. Other states, like Massachusetts, Rhode Island, and Delaware, have already implemented healthcare cost growth benchmarking.
The Oregon Health Authority is moving to expand treatment for hepatitis C, a disease that affects nearly 30,000 of the state’s Medicaid beneficiaries, to everyone on the Oregon Health Plan who’s infected, according to The Lund Report. In 2017, Oregon’s Medicaid program spent $45 million, about 7 percent of the total prescription budget, on hepatitis C drugs. The Governor has requested $107 million from the health authority in her budget proposal, one which the Authority plans to approve. Experts hope that treating hepatitis C will save Oregon the cost of treating people with severe complications while stemming the spread of the virus.
Oregon’s Medicaid coordinated care organizations (CCOs) got a shining report card on June 26—but it’s not clear how many of the metrics they’re being graded on are making the state’s healthcare system better, according to The Lund Report. The Oregon Health Authority will pay out $178.3 million to providers for meeting performance goals, but experts are divided on whether the annual report card reflects the overall goal of keeping prices in check and improving the health of patients. While some metrics, like vaccination rates, correlate to better member health, some believe that other metrics, like the share of child-bearing-age women using contraception, need to be amended.
Portland nonprofit Project Access Now, working with charitable funding from the metro area’s nonprofit hospital systems, has expanded its program offering free or heavily discounted generic drugs to working-class people with high-deductible health plans. According to The Lund Report, program participants pay either $4 per prescription or get their medications at no cost. Linda Nilsen, the executive director of Project Access Now, stated that, “pharmaceutical access is key to assuring improved health outcomes -- the remaining uninsured and underinsured still face significant barriers to getting the medications they need.” She believes that access to pharmaceuticals is key to improving health outcomes.
Oregon consumers are paying more and have less ability to make informed decisions about their health care due to opaque prices for healthcare services, according to a report released by OSPIRG Foundation and Frontier Group. The report provides an in-depth analysis of the power of price transparency to contain costs and improve the experience of care for patients and health care providers, and identifies evidence-based policies and strategies for Oregon to advance healthcare price transparency.“Most of us wouldn’t buy a toaster without knowing how much it costs. But you might have to buy a new knee, or an expensive procedure, without any clue what your bill is going to be,” said Jesse O’Brien, OSPIRG Foundation policy director and co-author of the report.
A new Oregon law requires pharmaceutical manufacturers to publicly disclose reasons for steep increases in drug prices, according to the Portland Tribune. Specifically, when the price of a prescription drug increases by more than 10 percent, the manufacturer is required to report the reasons to the Oregon Department of Consumer and Business Services. The information reported must include the cost of production of the drug, advertising, marketing, research and profits from the drug, and whether there are generic alternatives available. Civil penalties of up to $10,000 per day for noncompliance are built into the law.
A new report published in Health Affairs evaluated Oregon’s Coordinated Care Organizations’ (CCOs) progress towards the elimination of health disparities using claims-based measures of utilization, access and quality to assess baseline disparities and test for changes over time. The CCOs’ transformation and implementation of health equity policies was associated with reductions in disparities in primary care visits and white-black differences in access to care, but no change in emergency department use, with higher visit rates persisting among black and American Indian/Alaska Native enrollees, compared to whites.
According to the New York Times, in 2016, administrators began cherry-picking cases against the advice of doctors — turning away complicated patients and admitting only the lowest-risk ones in order to improve metrics, according to multiple interviews with doctors and nurses at the hospital and a review of documents.
According to The Lund Report, Rep. Rob Nosse plans to introduce legislation that will require pharmaceutical companies to provide state regulators with detailed explanations of price hikes and their products’ effects on healthcare costs, mirroring a California state law enacted earlier this month.
While the number of self-pay patients has continued to remain stable at just under 2 percent, charity care totaled $99.8 million in the second quarter of 2017, up 9.3 percent from $91.3 million in Q1. According to KTVZ News, this shows that despite increased coverage, hospitals are seeing increasing numbers of patients who lack the ability to pay because they are uninsured or have high deductible health plans.
Oregon’s Medicaid Coordinated Care Organizations held a sold-out Social Determinants of Health Conference that explored the diverse ways in which organizations are providing services that go beyond the scope of traditional medical care, according to The Lund Report. Programs profiled included a recent $21 million partnership that will fund the construction of 382 housing units in Portland.
A study using randomized controlled design to evaluate the effectiveness of improved communication and behaviorally informed “nudges” designed to increase Medicaid take-up among eligible populations showed that even low-cost interventions resulted in increased enrollment, according to Health Affairs. The effects were stronger among populations who had already expressed interest in health insurance but weaker among groups that had not. Using low-cost mass outreach efforts has the potential to decrease the rate of uninsured by increasing insurance coverage among vulnerable populations.
In 2012, Oregon moved the majority of its Medicaid enrollees into coordinated care organizations, leading to a 7 percent reduction in expenditures, according to this Health Affairs study. The savings were primarily attributed to reductions in the use of inpatient services. The transition also led to reductions in avoidable emergency department visits, some measures of appropriateness of care and, more concerning, to a reduction in primary care visits.
Medicaid Accountable Care Organizations in Colorado and Oregon both achieved improvements in service utilization, cost and quality of care, according to a new study in JAMA Internal Medicine. Oregon’s ambitious Coordinated Care Organizations were marked by heavy federal investment and a move to global budgets while Colorado’s Accountable Care Collaborative involved a much smaller state investment and retained fee-for-service provider reimbursement. The study showed that smaller investments such as Colorado’s can nonetheless lead to significant improvements.
The Oregon Health Authority has released its first quarterly report into the progress the state has made in reforming its Medicaid program, according to Herald and News. In 2012 Oregon launched a major health reform initiative and established 16 Coordinated Care Organizations to manage the Oregon Health Plan. The report shows that the Coordinated Care Organizations are financially stable and have made improvements in the cost and quality of care.
Oregon’s commercial health insurers can pay widely different amounts for the same procedure, according to a new report from the Oregon Health Authority. The report shows that for 46 common procedures, reimbursement rates can more than triple depending on the location of service and health plan being used. The first-of-its-kind report was made possible by a 2015 law that required insurers to report the median cost of payments made to hospitals.
Oregon Health Plan’s pay-for-performance program has continued to produce positive results in its third year of operation, according to a new report. Fifteen out of sixteen coordinated care organizations earned 100% of the quality incentives available to them under the program as metrics showed continued improvement in areas such as hospital readmissions, ER use, and patient satisfaction.
With the Affordable Care Act’s expansion of coverage, hospitals in Oregon are earning huge profits, allowing them to invest aggressively across the state, according to an editorial in Willamette Week. At the same time, critics contend hospitals are abusing their nonprofit status by falling short of their commitment to provide community benefits such as charity care.
When it comes to keeping members healthy—not just treating them when they’re sick—the Oregon Health Authority knows it can pay to be flexible, according to the author of this blog post. Oregon’s 1115 Medicaid demonstration project is allowing Coordinated Care Organizations to pay for non-medical services that improve the health of their members. Spending on ‘flexible services’ such as temporary housing and home improvements is aimed at addressing the social determinants of health that fall outside the scope of traditional medical care.
In 2008, following several years of capped enrollment, Oregon was able to enroll 10,000 additional people in its Medicaid program. Due to overwhelming demand, applicants were selected using a lottery system. The result of this unique process was effectively a randomized controlled study that allowed researchers to examine the impact Medicaid coverage had on the health and behavior of randomly selected individuals. This Health Affairs policy brief summarizes results from the Oregon Health Insurance Experiment as well as their implications for the ACA’s Medicaid expansion.
Beginning May 1, Oregon consumers can see proposed rates for 2016 individual and small employer health insurance plans.
Health insurance companies submitted rate requests to the Department of Consumer and Business Services, Insurance Division on April 30. The division must approve any rates before they can be charged to policyholders. Click here to see news release from the Oregon Department of Consumer and Business Services.
House Bill 2468 will enable state regulators hold insurers accountable for delivering access to needed healthcare services through provider networks. The bill passed the Oregon Senate today and is on its way to Gov. Brown’s desk. Read news release from OSPIRG.
The legislation would empower consumers to take personal responsibility for their own healthcare costs by improving access to healthcare prices.
Medical prices are often hidden until patients receive a bill, and many bills contain extra charges and surprise fees. Senate Bill 891 addresses these problems by requiring Oregon healthcare facilities to post their prices publicly, both at the facility and online, and to provide real-time price estimates for consumers on request.
“With Oregonians picking up an ever-greater portion of their own healthcare costs in the form of higher deductibles and coinsurance, it’s more important than ever for consumers to know the price of healthcare up front,” said OSPIRG Healthcare Advocate Jesse O’Brien. “We all know that healthcare still costs too much. The least we can do is make sure healthcare facilities post their prices, like any other business.”
Research shows that a lack of public information on the price and quality of healthcare services hampers competition and contributes to excessive spending by consumers, insurers, taxpayers, employers and other payers. The Institute of Medicine estimates that inflated prices due to lack of competition and excessive price variation cause $105 billion in waste in healthcare spending each year.
SB 891 will start addressing these problems by doing the following:
As a physician, I think my patients deserve to know the price for healthcare services so they can be empowered to make better-informed decisions,” said Senator Steiner Hayward. “Senate Bill 891 will strengthen the doctor-patient relationship by enabling physicians to start a dialog with patients about value in healthcare.”
“Senate Bill 891 is about personal responsibility,” said Senator Boquist. “If we want Oregonians to have the tools they need to take charge of their own healthcare, we must take action to make sure consumers can access accurate, actionable information about healthcare prices.”
For more information about SB 891, check OSPIRG’s fact sheet, available at http://bit.ly/1wRNBMF
Starting this month, the Community Health Centers of Benton and Linn Counties are taking part in a one-year pilot program that pays them a flat monthly rate for providing a full range of services to the 6,322 Oregon Health Plan members assigned to the county-run clinics in Corvallis, Monroe and Lebanon.
Rather than billing OHP (Oregon’s version of Medicaid, the federal insurance program for the poor and disabled) on a fee-for-service basis, the Community Health Centers will receive a single payment each month from the InterCommunity Health Network, the regional coordinated care organization for Linn, Benton and Lincoln counties.
The clinics are to receive payments ranging from $15 to $86.36 a month for each assigned patient, depending on which risk-weighted rate group the patient falls into. The estimated revenue for the clinic is $170,041 a month, or just over $2 million for the year, though the amount will be adjusted periodically as the numbers and types of OHP patients change.
IHN is providing an additional $400,000 or so to cover most of the cost of salary and benefits ($408,000) to add the equivalent of five full-time staff members for the clinics, and the two parties have agreed to a set of benchmarks to measure how well the system is meeting goals for access, quality of care and utilization.
Click here for more information.
A recent webinar describes preliminary findings from an analysis of Oregon's Coordinated Care Organizations (CCOs), which are the state's version of Accountable Care Organizations (ACOs) for Medicaid. The webinar explores the organizational structures and operational approaches of Oregon's CCOs and examine how CCOs—and the variation among them—impact healthcare access, use, quality, and costs. Findings: Use and expense for primary care services increased; Use and expense for specialty care services decreased; Pharmacy use decreased but expense increased. No significant changes for MH, ED or IP. The webinar can be accessed by clicking here.
An OSPIRG Foundation report analyzed the impact of health insurance rate review on 2015 premiums for Oregon individuals, families, and small businesses. The report revealed that one insurer made a major error in its initial filing, and some insurers overstated trends in medical costs. The report noted that the state Department of Insurance review ensured that provider savings from reductions in uncompensated care (due to the expansion of health coverage under the ACA) were passed along to policyholders.