August 2010

Oregon Health Policy Board Committee Updates

This e-bulletin provides updates on the work of the committees, workgroups and councils of the Oregon Health Policy Board and Oregon Health Authority's health reform work. You received this bulletin because you are subscribed to an Oregon Health Authority or Oregon Health Policy Board e-mail notification service. This bulletin is sent monthly and describes the work completed last month, as well as expected agenda items, meeting times and locations for the following month.

You can learn more about the work of committees, workgroups and councils on the Board's committee webpage and in the committee overview.

The Oregon Health Policy Board meets August 10. The meeting agenda can be found online.

Administrative Simplification Workgroup

The group has made its recommendations to the Health Policy Board. The board is scheduled to take action on the recommendations at the August 10 meeting.

Healthcare Workforce Committee
Next meeting: 1- 4 p.m. on August 18, Portland

Having completed their inventory of workforce resources, in July the committee focused on recommendations in three initial priority areas:

• Preparing current and future health care professionals to support system transformation via emerging models of integrated, team-based care delivery;
• Building the size and capacity of the healthcare workforce, particularly primary care; and
• Strengthening the healthcare workforce pipeline to ensure that Oregon has enough health care workers with the right training in the right places workforce.

The committee debated some specific strategic recommendations under each of these priorities, looking for removable barriers or early action steps that can accomplish their priorities but may not need a large infusion of dollars due to the severe budget crisis facing the state. However, the committee also noted the urgent need for workforce investments such as in education and loan repayment. They discussed the need for different types of curriculum necessary for enhanced care coordination and inter-professional training to prepare the workforce for the medical home model workplaces. To assist their understanding, the committee heard from representatives from the CareOregon and Oregon Primary Care Association safety net medical home pilot project who shared their clinics' observations about workforce needs and opportunities in the medical home team-based model. Based on July's discussion, more focused recommendations and needed action steps for each of the priority areas are being developed for review at the August meeting. A final version of their short-term strategic priorities and recommendations, with suggested action steps, will be presented at the October Oregon Health Policy Board meeting. The committee also identified the need to closely coordinate its work with the efforts of the other committees. It will identify member volunteers to attend or participate in other committee meetings.

Health Incentives & Outcomes Committee

The full committee met to review and align the work of its two subcommittees. The committee approved principles for payment reform strategies. Members had a detailed discussion of how the initial set of recommended quality metrics need to compliment the initial payment strategies to provide a means of measuring health outcomes and support payment approaches.

• Payment Reform Subcommittee of the Health Incentives & Outcomes
  Next subcommittee meeting: 1- 3 p.m. on August 12, Portland
  
  At the last meeting, the subcommittee discussed some of the data and evidence that could be used to identify opportunities for reform. It agreed to work with staff in small staff review panels to develop recommendations for payment reform, focusing on three areas: 1) hospitals; 2) specialty care; and 3) primary care, building on the previous patient centered primary care home standards work. The full subcommittee will look across these three groups to develop a set of initial payment recommendations, focusing on steps that can be achieved over the next 1-3 years. This will include looking at federal requirements and reform, and where there is large variation in payment, approaches or costs based on current data and evidence. The recommendations will also have a strong focus on chronic disease care because it is a key driver of health care costs.
  
  Discussions included determining and aligning the current variability of payment approaches, such as variation in diagnose-related group payments with hospitals is one area anticipating that greater uniformity of payment could improve efficiency of payment transactions and be a base to build an incentive, outcome-based payment methodology. There was also discussion of looking closely in the area of cardiology and orthopedics as initial areas of focus in specialty care.
  
  The workgroups will be meeting in early August. They will come together for the full subcommittee August 12. The subcommittee's recommendations will be aligned with the quality outcome metrics being developed in the Efficiency and Quality Subcommittee. These will be used in the full Incentives and Outcomes report at the October Oregon Health Policy Board meeting. The metrics will also be used by the Public Employers Health Purchasing Committee to consider for contract changes for health care purchasers.


• Efficiency & Quality Subcommittee of the Health Incentives & Outcomes
  Next subcommittee meeting: 10 a.m. - noon on August 12, Portland
  
  At the last meeting, the subcommittee reviewed the quality & efficiency priorities and the work of its small workgroups that were focused on three areas 1) effectiveness and safety, 2) patient-centeredness; and 3) cost and efficiency measures. The workgroups are now identifying how to focus on those metrics that are most useful for payment reform initiatives as immediate next steps. This will allow them to narrow the subcommittee's inventory of the most common measures in each focused area, and refine the list to key metrics for the anticipated areas of new payment strategies that address high variation in cost or utilization or effect chronic diseases. There is a recognized need to build on currently collected chronic disease metrics by Quality Corp, those of the Patient Centered Primary Care Home Standards work, as well as the newly finalized Health Information Technology Meaningful Use requirements in order to build on state and federal efforts already in place or almost underway. Also, they have reviewed upcoming Medicare and Medicaid quality metric changes that are anticipated. They realize their work needs to be usable to purchasers, such as those represented on the Public Purchasers' committee, for inclusion into contracts. Staffs from both this subcommittee and that of the payment subcommittee are working closely to align the work of each for the groups' discussion. The workgroups' preliminary recommendations will be discussed at the Efficiency and Quality subcommittee in August, and then further refined in September and discussed at the full Health Incentives and Outcomes committee. At the October Oregon Health Policy Board meeting, the board will be presented with recommended initial state quality improvement strategies that align with the recommended set of payment reform strategies that will aim to address chronic disease and high variation in cost, quality or utilization.

Medical Liability Task Force
Next meeting: 1 - 4 p.m. on September 8, Wilsonville

The task force, in defining how they would approach their charge, finalized their principles that any recommendations should:

• Make the medical liability system a more effective tool for improving patient safety;
• Ensure that it more effectively compensates individuals injured as a result of medical errors; and
• Reduce its collateral costs (including costs associated with insurance administration, litigation, and defensive medicine).

Using these principles, the task force has focused its work on three main approaches to review: disclosure and offer; administrative "health courts"; and safe harbor provisions.

At the July meeting, the task force discussed disclosure and offer programs with a focus on PeaceHealth's efforts in the area of early disclosure of errors, and the role the Patient Safety Commission's reporting could play as they consider recommendations in this area. Some straw recommendations on disclosure and offer were initially considered at the August meeting but the majority of the time was spent on health courts, including a discussion with a national expert.

The health courts discussion highlights included how there could be an alignment with the earlier discussed disclosure and offer in setting up this administrative approach to assess liability concerns how further detailed analysis on potential impact and some interest in consideration of developing a pilot approach to better assess its effectiveness at achieving the task force's principles. There was a brief discussion on the concept of a provider reinsurance pool, as an addition to the disclosure and offer recommendations and concerns were raised that though extensively discussed in past liability task forces or work groups, it doesn't fit with the principles they are using to evaluate approaches, and there is the issue of how it would be funded. September's meeting will focus on safe harbor approaches and review of some straw recommendations regarding health courts. The task force will be finalizing its recommendations in October to prepare for presentation to the Oregon Health Policy Board in November.

Public Employers Health Purchasers Committee
Next meeting: 1 - 4 p.m. on September 27, Wilsonville

In August, some members of the committee will be meeting with the Physician Hospital Alignment for Central Oregon in Bend to learn about their efforts and how that model could be adapted for use in other communities. Some members and staff will also be meeting with health systems to discuss diagnosis-related group hospital reimbursement methodologies for a report to the full committee in September.

Health Information Technology Oversight Council (HITOC)
Next meeting: 1- 5 p.m. on September 2, Salem

The committee held a webinar public meeting to review the operational plan and draft budget for a health information exchange. The discussion included the timing of technology purchases to support providers' eligibility to receive incentive payments from Medicare and Medicaid for the meaningful use of electronic health record systems. At the August meeting, HITOC approved the Strategic and Operational Plans for Health Information Exchange for submission to the Office of the National Coordinator, and discussed the process of building the new structure of workgroups and advisory panels for the next phase of work outlined in the health information exchange operational plan.

Oregon Health Improvement Plan (HIP) Committee
Next meeting: 10 a.m. - 2:30 p.m., September 10, Woodburn

In June, the HIP Committee synthesized the previous three months of information gathering and community engagement into core goals and recommendations for the health improvement plan. These were presented as a draft to the Oregon Health Policy Board in July. The HIP committee did not meet in July. Based on the Board's feedback and public input, at the August 6 committee members worked to further define specific actionable strategies and population health outcomes for each of the six goal areas (equity, resources, community infrastructure, tobacco, obesity and chronic disease self-management) and began to work out timelines for actions in the next and future biennia.

Health Insurance Exchange

Staff recommendations for the development of an exchange will be presented at the August board meeting. The recommended policy choices will help the state establish a health insurance exchange, a central marketplace for purchasing health care insurance, within the framework established in federal law.

Essential Benefit Package

While the Cost Sharing Workgroup initial work is completed pending more federal reform details, the Oregon Health Authority is assessing the marketability and administration issues of the value-based benefit design under discussion. Presentations on the Essential Benefit Package similar to that given at the July Oregon Health Policy Board meeting were subsequently given to the Public Employees' Benefit Board (PEBB) and the Oregon Educators Benefit Board (OEBB). Further modeling of the package using commercial data will be done to provide assistance to these boards as they consider this plan design as an option. In the fall, staff will give the Oregon Health Policy Board an update on the assessment of marketability and administration issues, commercial data modeling, and the status of published federal health reform regulations as they become. This will better inform the value-based benefit discussion.

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