July 11, 2011

The 2011 legislative session was historic for health and health care in Oregon. The Legislature passed Senate Bill 99, setting up the Oregon Health Insurance Exchange, which will act as a one-stop marketplace for individuals and small businesses purchasing health insurance. The Legislature also passed House Bill 3650, the Health System Transformation bill designed to improve care and lower costs by changing the way health care is delivered in our state.

The end of the legislative session and the successful passage of these important bills is the culmination of months (and in some cases years) of hard work by the members of the Oregon Health Policy Board, stakeholders, consumers, industry leaders, and advocates from around the state who have helped to make these health innovations possible.

But time for reflection is short lived. Implementation and design work is beginning. Both will involve citizen boards and workgroups to help us move forward. Information about applying for the Health Insurance Exchange Board or the OHPB Health System Transformation work groups can be found below, in this month's edition of the OHA-OHPB E-Bulletin.

Success in developing plans for the Health Insurance Exchange and Coordinated Care Organizations will depend on public participation and gathering the best thinking in our state. To that end, Governor Kitzhaber and the Health Policy Board are calling for nominations of individuals to join the process. There are opportunities for short-term service on Oregon Health System Transformation (HB 3650) work groups and longer-term service on the Oregon Health Insurance Exchange Board of Directors.

For more information about the scope of the board and the work groups and to apply, please go to Health.Oregon.Gov. Applications are due by 9 a.m. Friday, July 15, 2011.

More than 1.8 million Oregonians suffer from arthritis or chronic joint conditions. Doris Lily is one of many people around the state taking advantage of the Arthritis Exercise Program in the Oregon Health Authority's Public Health Division. The program works to keep people with arthritis moving more freely and without pain – and in turn helps lower health care costs associated with this disease. Lily liked the program so much that she became a master trainer: "I see people come in with a walker or a cane and we work on different walking patterns. Then, all of a sudden, they are walking without holding onto something. Their balance and strength have improved," Lilly said. According to Danna Hastings, OHA's chronic disease program manager, movement is simply the best way to treat arthritis and reduce the pain associated with it.

The Oregon Health Authority, working in partnership with the Northwest Health Foundation, continues to collect health care stories to show what's working – and what could be better – in our state's health system. You can read about the Arthritis Exercise Program, as well as send us your stories here.

Senate Bill 99
On June 7, the House passed SB 99, which establishes the Health Insurance Exchange Corporation to design and build our state's exchange. Through the exchange people and small businesses will have access to affordable coverage that will meet the high quality standards established by a citizen board of directors. No later than February 1, 2012, a business plan for the exchange will be presented to lawmakers for review. After approval, the exchange will begin providing coverage in January 2014; it's estimated that some 350,000 Oregonians will ultimately use it to gain access to their health insurance coverage.

Rocky King, who was part of the exchange design team for the Oregon Health Authority, has been appointed interim director of the Exchange Corporation by Governor Kitzhaber.

House Bill 3650
The Health System Transformation bill (House Bill 3650) passed on the evening of June 29. The bill proposes to redesign the Oregon Health Plan with the goal of better coordinating care to improve access to primary and preventive care and to break down barriers between physical, mental, and other types of care. OHP serves some 600,000 Oregonians.

The vision of HB 3650 includes a plan for the creation of community-based coordinated care organizations (CCOs) that would focus on patient outcomes, would integrate physical health, mental health, and oral health, would be required to manage costs within a global budget, and would have local flexibility to allocate resources.

Under HB 3650, with approval by the Legislature, the first CCO would launch in July of 2012, just about one year from now. Before that, there are key elements of House Bill 3650 that are to be fully developed and then reviewed by the Legislature at the February 2012 session: a methodology for developing a global budget; a set of criteria for CCOs; outcomes and quality metrics; and a plan to integrate care for individuals who are eligible for both Medicare and Medicaid.

OHA budget
The 2011 – 2013 Oregon Health Authority budget passed by the Legislature includes some significant reductions. Due to rising costs, rising caseloads, and the loss of nearly $1 billion in federal stimulus funds, nearly every person who receives or provides services funded through the Oregon Health Authority budget will be affected by the reductions.

Agencywide, most budget reductions made in 2009 – 2011 will continue through 2011 – 2013. In addition, $44.3 million, or 19 percent of the OHA state General Fund administrative budget will be cut. We will continue to increase efficiencies through lean management techniques, reduction of unnecessary processes, and continually improving services.

However, because most of the OHA budget pays for health care, providers of the Oregon Health Plan will be taking a significant reduction. We have been working closely with them to help implementing the reductions, and will continue to do so over the coming months.

The OHA website has more information about the budget here.

The Oregon Health Study
Research in Oregon on the benefits of providing medical insurance to the poor made national headlines last week after a report was published by the National Bureau of Economic Research. The report showed that people covered by Medicaid reported being healthier, happier, and more financially secure. This report answered tough questions about issues that have long been at the center of the debate on the effectiveness of state-sponsored health care. In 2008, budgetary restrictions forced Oregon to create a system in which people were randomly selected from a reservation list to determine who could apply for the Oregon Health Plan. This unintentionally created the perfect conditions – a randomized, controlled study – to test the benefits of providing health insurance to the poor. The Oregon Health Study was conducted in collaboration with the Oregon Health Authority by researchers from Providence Health & Services, Massachusetts Institute of Technology, Harvard School of Public Health and the National Bureau of Economic Research. More details on the report and its findings can be found in this New York Times article, this report in the Oregonian, and in various other news outlets. Full text is available at www.nber.org/papers/w17190.

Oregon's Healthy Kids program delivers in a big way.
New results from the Oregon Health Insurance Survey show that the percentage of uninsured children in Oregon has dropped significantly – from 11.3 percent in 2009 to 5.6 percent in 2011 – since the creation in 2009 of the Oregon Healthy Kids program. The program offers affordable, high-quality health insurance to all Oregon children and teens 0-18 years old. When the program was launched two years ago, OHA leadership set a goal of bringing 80,000 children into care, a goal that has been met and exceeded.

"The Healthy Kids Program shows that Oregonians know how to step up and solve the problems in our health care system," says Bruce Goldberg, M.D., Oregon Health Authority Director.

The official press release can be found here.

The next Oregon Health Policy meeting will take place July 12, 2011, from 8 a.m. to 1 p.m. at the Market Square Building in downtown Portland. The focus of the meeting will be mapping out a strategic plan for the board to begin implementing HB 3650 over the upcoming months.

Connect with us: Use Facebook.com/OregonHealthAuthority and Twitter.com/OHAOregon to find out about OHA events, public input opportunities, transition updates, and federal and state health reform news.

Send input and comments to OHPB at ohpb.info@state.or.us
View calendar of health reform meetings

The Oregon Health Authority is the organization at the forefront of lowering and containing costs, improving quality, and increasing access to health care in order to improve the lifelong health in Oregon. The Oregon Health Authority is overseen by the nine-member citizen Oregon Health Policy Board working towards comprehensive health and health care reform in our state.