1. Jeanene Smith MD, MPH Office for Oregon Health Policy and Research SCI Coverage Institute - July, 2009 Albuquerque, NM Building a Healthy Oregon: Delivery System Redesign & Quality

2. Health policy reform in Oregon over the last two decades 1980’s - Pre-Oregon Health Plan: early pioneers in managed care in selected cities 1994 - Oregon Health Plan: Prioritized List, hi-risk pool, created a policy office, aimed for an employer mandate 2003 - OHP2: reform efforts thwarted with budget cuts due to recession 2007 - Oregon Health Fund Board: statewide health reform planning process Now - HB 2009/2116 & Oregon Health Authority

3. Oregon Health Fund Board, 2007-08 7 member citizen board Six committees –Benefits, Eligibility and Enrollment, Finance, Health Equity, Delivery Systems, Federal Laws Two workgroups –Health Insurance Exchange, Quality Institute Over 110 public meetings with 20 town hall meetings across state Over 1,500 comments received through meetings and written comments

4. Oregon Health Fund Board’s “ Action Plan to Build a Healthy Oregon” Two track approach: –Expand Coverage –Contain Costs and Improve Quality Keystone: Oregon Health Authority –Single state agency to act as a smart purchaser, integrator of services, and instigator of innovation

5. Oregon Health Fund Board’s “ Action Plan to Build a Healthy Oregon” Short-term impact –Cost and quality will be compared –Local innovation will be supported –Cover 1/3 of uninsured Oregonians (approximately 15,000) –Prevention and primary care will be emphasized

6. Oregon Health Fund Board’s “ Action Plan to Build a Healthy Oregon” Long-term impact –Reduce chronic disease, obesity, tobacco use and substance abuse –Address health care workforce –Adopt private, secure electronic medical records –Bend the health care cost curve –Provide affordable quality health care to all Oregonians

7. Legislative Action in 2009: Companion Bills for Health Reform HB 2116 –Affordable coverage for all children –Expand OHP Standard by 35,000 –Paid for by 1% assessment on insurers, 2.8% on large hospitals HB 2009 –Creates the Oregon Health Authority, overseen by the Oregon Health Policy Board –Sets system reform in motion through key cost containment and quality measures

8. HB 2009 – Setting Reform in Motion: Gaining Value and Cost Savings Care Coordination: –Statewide registry of physician orders for life sustaining treatment orders (POLST) –Implement uniform quality standards and payment reform, starting with primary care and chronic disease –Uniform use of Evidence-based health care guidelines and comparative effectiveness standards –Health Information Technology Oversight Council (HITOC)

9. HB 2009 – Setting Reform in Motion: Gaining Value and Cost Savings Improved Transparency All-claims, all payer database Public reporting on proposed hospital and ambulatory surgical center capital projects Healthcare workforce database and coordinated policy

10. What were our challenges? Tough Economic Times No extra dollars to increase primary care payments beyond current for “medical home” No extra dollars for grants to communities to aim for “healthy communities” for those medical homes to live in No “Quality Institute” yet, just initial steps to set standards

11. What were our challenges? Gaining consensus Months of discussion of the Board and it’s Delivery Committee to reach the final recommendations New challenges arose when session began: –Legislators getting up to speed and adding their perspective –Plus the lobbyists take their turn

12. Next Steps – Implementing a Healthy Oregon Managing Expectations: System changes starting while also re- aligning how state govt. health functions are managed – the new “Health Authority” Stakeholders all wanting to shape implementation to their reading of legislative language

13. Next Steps – Implementing a Healthy Oregon Align across state entities – common work plans under new Health Authority Communicate and work with stakeholders – public process so integral to Oregon Avoid just more planning - aim to incent change in how we pay & expect from our partners to deliver quality healthcare

14. For more information Oregon Health Fund Board materials available at: http://www.oregon.gov/OHPPR/HFB/index.shtml http://www.oregon.gov/OHPPR/HFB/index.shtml HB 2116 & HB 2009 available at: http://www.leg.state.or.us/09reg Oregon Health Policy & Research –Website: www.oregon.gov/ohprwww.oregon.gov/ohpr –Call us at 503-373-1779 –Email at jeanene.smith@state.or.usjeanene.smith@state.or.us