1. Lessons Learned from Health Care Reform Presentation to Citizens’ Health Care Working Group September 23, 2005 Jean Thorne, Administrator Oregon Public Employees’ Benefit Board (PEBB)

2. 2 Background  State Medicaid Director 1987-1995  Director, Department of Human Services 2003-2004  Administrator, PEBB 2004-Present

3. 3 Pre-Oregon Health Plan  1987 Coverage for transplants discontinued Coverage for pregnant women and children expanded Discussion of trade-offs begins  1988 Growing public awareness of need for health care reform

4. 4 Pursuing Federal Waivers for OHP  Criticism from national advocacy groups  National press focus on health care “rationing”  Importance of a united front  Discussion of trade-offs  National reaction when waiver denied

5. 5 Implementing the OHP Changes occurring Benefits based on prioritized list Managed care delivery system Expansion of eligibility to FPL Approach Start-up would not be delayed Constant communications We’re all in this together

6. 6 OHP Start-Up (under a national spotlight)  Cries for coverage  No “big stories”  Change in press focus  Working through the kinks  Involvement of advocates  Being part of positive change

7. 7 Use of the Prioritized List  Tool to force explicit policy decisions  Allowed policy makers to reduce services in rational manner  Unwillingness of federal government to accept  Impact on ability to sustain program

8. 8 Purchaser Role in Moving Change  PEBB Vision for 2007 Systems of care Outcomes Evidence-based medicine Transparency  Need for provider ownership  Collaborative efforts in a competitive market?  Challenges in engaging members

9. 9 Lessons Learned  We’re all part of the problem – and the solution  No magic bullets – trade-offs are necessary  Need for provider ownership to achieve change  Importance of credible political leadership  Stakeholder groups can help  Media can be a partner

10. 10 Challenges  Limitations of a competitive model  Need for all providers to focus on greater good  Limitations of a consumer-based approach  Limitations of a purchaser-based approach  Gaining public understanding of a complex issue