Oregon Department of Human Services Director's Message
October 1, 2010 DHS Director's messages on the web
To: All DHS and OHA employees
From: Bruce Goldberg, M.D., Director

Health Reform Update

"The great thing in the world is not so much where we stand, as in what direction we are moving."
~Oliver Wendell Holmes

Sept. 23 marked the six-month anniversary of the passage of the national health reform bill, so I thought it appropriate to provide you a quick update as to where things are at both the state and national levels.

Last week some important elements of federal health reform went into effect that will provide greater protections for people of all ages. For example, under the national law, no insurance company can deny coverage for children under 19, even if they have a preexisting condition. All new health care plans must cover preventive care without copays and exempt from deductibles. There will be no more lifetime limits on health care coverage.

Sadly, a few insurers have decided to no longer offer new children's health policies. Fortunately, most of Oregon's health insurance companies will. The strength of our state's insurance market has always relied on our state insurance carriers serving all populations. Those that continue to offer kids coverage should be applauded. Cathy Kaufmann and Tom Jovick with OHA, and Teresa Miller with the Department of Consumer and Business Services are all working together to assure that Healthy Kids, our high-risk insurance pool, and the commercial health insurance market are all coordinated to ensure children can get coverage.

In Oregon, we are moving forward many of our own reforms through the work being done by the Oregon Health Policy Board and the Oregon Health Authority.

The board holds public meetings every month that are web streamed live at: www.oregon.gov/oha/ohpb. Since its formation after the passage of House Bill 2009, the board has been moving quickly with plans that will improve the quality, access and cost of health care in our state. A few of the notable accomplishments follow; I know that there are many more to come.

Health Insurance Exchange. Earlier this month board members traveled to six community meetings around the state to get public input on how a health insurance exchange should be structured and governed here in Oregon. More than 800 people attended the meetings and more than 600 have provided feedback on the website. That feedback will be used to form the plan for the exchange that will be presented to the 2011 Legislature.

Administrative simplification. The Oregon Health Policy Board has endorsed a plan that will help health care provider and plan offices save time and reduce cost. The plan calls for automated electronic processes for communicating and conducting basic business transactions in a uniform language, which is projected to save $93 million or more annually in administrative costs by 2014. Medical practices will see savings - mostly in the form of reduced staff time processing claims and payments and making phone calls to health plan offices to check patient coverage, including patient benefits and cost-sharing responsibility. Hospitals and health plan staff time will be saved as well.

Patient-centered primary care homes. Primary care homes are a model of care where the patient and family are at the center of care. They help provide and coordinate care to better meet the needs of the person and make it easier for them to get the care they need. In Oregon, we are setting standards to guide these important improvements in patient care and we are involved in getting a number of pilot projects off the ground.

Creating a health information technology infrastructure. The Oregon Health Authority's Health Information Technology Oversight Council recently submitted its strategic and operational plans for the exchange of health information. As a result, medical records are available when and where they're needed to improve Oregonians' health and our health care system.

Improved patient care. One of the important roles of the Health Authority will be to enable local projects that improve health and take those lessons to the rest of the state. To that end, we have finalized an agreement with the Central Oregon Regional Health Authority Transitional Board this month, which begins that process in three counties. The regional health authority will help lead to better integration and coordination of health care, public health and behavioral and mental health care services. It will help assure that individual and community health needs are treated holistically and that resources are used efficiently.

Expanding access to quality, affordable care. Thanks to the great work of Tom Jovick and his team, we have quickly implemented the new federal high-risk insurance pool. The new insurance pool adds another option for uninsured Oregonians with existing medical conditions to purchase health insurance, in addition to the existing Oregon Medical Insurance Pool (OMIP). This federally funded program will be available until 2014, when insurers will no longer be able to deny coverage based on preexisting conditions and the health insurance exchange is operational.

Focus on prevention and providing incentives for preventive and primary care. OHA and the Oregon Health Policy Board are developing a model health insurance benefit that will help keep people healthier and make health care more affordable for all. The model, called a value-based benefits package, will ensure that the highest value services received at the doctor's office - those that promote health and prevent illness and help prevent the complications of chronic illnesses - are free or low-cost to patients. Lower value or elective services will still be available, but will have some cost sharing. The package will encourage consumers to use preventive services and those that help keep people healthy and contain costs.

It's an impressive start, but a lot of work and a long road ahead remain. I will keep you posted.

DHS on the web