If you are a health advocate, and Oregon Health Plan member, or a contracts lawyer, then you have a chance to help the state get the details right of how it spends billions in coming years.
Oregon on Friday kicked off the biggest bout of contracting in state history and at the same time allowed the first detailed public look at how --for years to come-- it intends to administer the multibillion-dollar program. The OHP provides health care to one in four Oregonians, the most needy among us, using private-sector firms that operate like insurance companies.
Even if you're not among the low-income people served by the program, you're probably helping pay for it. In 2017 state coffers provided $2.3 billion of the Oregon Health Plan's $8.4 billion in overall spending.
The state disclosed for public comment the draft solicitation that will offer companies and nonprofits a five-year pact to oversee a portion of the privatized Oregon Health Plan, with the opportunity to comment closing on Jan. 14.
The move is about more than a contract. It signals the potential to further Oregon's quest to improve care while also saving money, the goal of legislative reforms in 2011 and 2012.
OHP has for years used a mix of private and nonprofit firms to manage care under the program, which spent more than $8 billion in 2017. The 2012 reforms led to five-year contracts being issued to 16 managed-care-type entities called "coordinated care organizations," which were then extended for a year.
One of the care organizations, Portland-based FamilyCare, pulled out of the market complaining of low rates and alleging disparate treatment by the state.
Many of the remaining CCO plans have since reported losses as well, even as other aspects of the program overseen by the Oregon Health Authority have generated a series of negative headlines.
OHA Director Pat Allen was brought in to the fix the problems. He's promised the new contracts will bring more accountability and transparency, two of the marching orders given to him when Gov. Kate Brown put him in the post.
In an interview last month, he said the next round of care organization contracts will be key, noting that the first round of contracts in 2012 were more "aspirational" than enforceable —as was fitting since nobody was sure how the reforms would work.
These days, he told the Tribune, "we don't have some of the same fears and challenges that we did six years ago" in the program.
The Oregon Health Authority announcement of the public comment period included further comment attributed to Allen.
"CCOs are a critical component of health transformation in Oregon," said the statement. "The standards and expectations that will guide their selection are important to many stakeholders, not only to those who may apply. This is why I want to provide an opportunity for Oregonians to let us know if we've hit the mark on setting expectations for CCOs that will improve care for members and transform our health care system."
The announcement also notes the priorities driving the changes in contracting, which were contained in a letter to Allen from Gov. Kate Brown.
•Improve behavioral health
•Increase the use of creative payment reforms to get better value care
•Focus on equity as well as areas such as housing that contribute to good health.
•Control cost growth while ensuring tranparency in the finances of delivering care.
Reforms lagged
Oregon's 2012 reforms are thought to have in some ways, and continue to draw attention from national experts.
But the priorities listed by Brown echo some of the concerns raised over the CCO reforms here in Oregon — for instance that CCOs are able to generate profits that are not reported, and that they have not done as much as promised in terms of crafting payment reforms and integrating behavioral health with medical care.
Many of the policy goals spelled out in recommendations for this round of contracting "are already in place in some form but have never been enforced or results have not been reported," from Clackamas, Multnomah and Washington counites commenting on the new round of contracting.
Moreover, after state spending was capped during the early part of the reforms, rates approved to pay CCOs have exceeded 5 percent a year for two years in a row, significantly above the "sustainable" growth cap promised by the reforms.
For more information on the contracts and expectations attached to the Oregon Health Plan's future, or to submit comments,
This is the fourth article resulting from the Portland Tribune's participation in the 2018 Reporting Fellowship on Health Care Performance, which is supported by the Commonwealth Fund and sponsored by the Association of Health Care Journalists.
Reporter Nick Budnick is looking at reforms to the Oregon Health Plan, where they've succeeded and where they haven't.
