Sunday, November 23, 2008

Board Releases Plan

The Oregon Health Fund Board established by the Oregon legislature released their November 2008 Blueprint to reform Oregon’s healthcare system. The plan “Aim High: Building a Healthy Oregon” stresses that Oregon needs to have a healthy population, provide extraordinary patient care, and provide for reasonable per capita costs to be shared in an equitable way by the entire population.

The overreaching strategy for the State is to establish partnerships with communities, to provide health insurance to all the children, ensure transparency for information on costs and health outcomes, unify purchasing power, stimulate innovation, ensure health equity for all, train a new healthcare workforce, and advocate for Federal changes.

An important goal of the plan is to provide the strategies to stimulate system innovation. One of the prime strategies would be to develop Integrated Health Homes (IHH) to guide primary care practice transformation across the state. While this model allows for many different care settings to serve as integrated health homes, they all share common features.

For example, IHHs would establish personal and continuous relationships with patients, provide team-based care, provide culturally competent care for all of a patient’s healthcare needs, coordinate and integrate care with the care received from other providers and organizations, focus on quality and safety, and provide patients with enhanced access to care.

While integrated health homes are just starting to be implemented in the U.S. on a large scale, there have been a number of local demonstration projects that have shown some tangible results. For instance, the South Central Foundation in Alaska implemented an IHH model at the Alaska Native Medical Center. This IHH model has improved care measures over a five year period, decreased disease-specific hospitalizations, improved childhood immunization rates, and decreased emergency room, specialists, and provider visits.

A care-management based integrated health home model was also implemented at the Intermountain Health Care in Salt Lake City resulting in significant health improvements, including improved glucose control. As a result, hospitalization and death rates have decreased in elderly patients with diabetes as compared to patients at control clinics.

However, the plan points out some of the action steps that need to take place. First of all, a system needs to be created where IHHs report requirements on process, outcomes, and quality metrics, standards need to be established for reimbursing designated IHHs, and standards need to be developed with contracted health plans. Additionally, IHHs need to be incorporated into the Oregon Health Plan (OHP) with incentives for OHP participants, and learning collaboratives need to be established for IHHs.

The plan also addresses changes needed in payment reform to encourage high quality healthcare delivery in the state. The state’s role as both the integrator and instigator of system change can be the key to improving the payment system to pay for the quality of care rather than the quantity of care.

The first action step should be to establish a Payment Reform Council to explore new payment models to reward providers for the quality of care they provide in coordination with providing incentives for innovative models of care that ensure care coordination and efficiency, such as an IHH. Secondly, there is the need to promote evidence-based practice under clearly articulated state policies and active supervision.

Another step in the right direction would be to continue to support community-based collaboratives to develop innovative programs and relationships to better integrate healthcare across multiple local organizations, and one of the ways that this can happen would be for the state to establish challenge grants. The grants could be in the form of direct financial or technical assistance and would require local matching funds and specific performance objectives and measures.

The plan also addresses Federal actions that are needed. Today, the most critical federal barrier to health reform in Oregon relates to the low Medicare reimbursement rates paid to Oregon’s providers as compared to other states and regions. Congress needs to reform the process for setting Medicare rates to more equitably align reimbursement across the country, preserve the option of Medicare Advantage HMO and PPO plans, provide for additional Medicaid waivers and expand the program, enhance tax benefits for self-employed individuals and other individuals buying health insurance on the open market, address healthcare provider workforce issues, and provide for open dialogue among provider organizations concerning delivery system changes.

The plan will be sent to the Governor and the Oregon Legislative Assembly for consideration beginning January 2009. To view the entire report, go to