Medicaid action plan on track for on-time completion

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Issues and actions in Oregon health today

July 21, 2017

Medicaid action plan on pace for on-time completion

This summer, a team of Oregon Health Authority staff and outside contractors are completing Medicaid eligibility renewals for approximately 115,000 cases previously contained in the Cover Oregon database and other legacy systems. As of mid-July:

  • Workers had cleaned up more than 79,000 of the outstanding cases, putting OHA on track to finish the work by the Aug. 31 deadline.

The painstaking work entails verifying whether an adult or child who receives health coverage under Medicaid is still eligible to receive it. OHA eligibility workers must manually transfer case files from outdated or failed databases into the state’s new ONE system.

ONE allows Oregon Health Plan members to apply for (and renew) benefits online. OHA and DHS are collaborating on a project to centralize the application process for food stamps, temporary assistance, Medicaid and other benefits in ONE.

OHA Action Plan Updatedotted line for divider

Oregon CCOs continue to advance health reform

Oregon’s coordinated care organizations continue to advance health system transformation by focusing on better care and better health outcomes while controlling health care costs. That’s the takeaway from two recent reports on the performance and stability of CCOs: the Oregon Health System Transformation Quarterly Legislative report and the CCO Metrics report.

Highlights of the CCO Metrics report show continued improvements in a number of key areas, including:

  • Adolescent well-care visits. CCOs continue to make large strides on this measure, with 15 of 16 CCOs improving in 2016 and 13 achieving their individual improvement target.
  • Effective contraceptive use among women at risk of unintended pregnancy.  A new measure in 2015, the percentage of women ages 18 - 50 who are using an effective contraceptive has increased 19 percent in two years.
  • Developmental screening in the first three years of life. CCOs continue to make large strides in the percentage of children who are screened for risks of developmental, behavioral, and social delays. In 2011, only 21 percent of young children received an appropriate screening. Since then, the percentage has more than tripled to over 62 percent in 2016.

Read both reports on our website.

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Teams advance behavioral health integration

The Behavioral Health Collaborative (BHC) has convened five workgroups to further recommendations that will move the state’s behavioral health system to a coordinated care model. The goals are to integrate behavioral health with physical and oral health and to develop minimum standards so all Oregonians receiving behavioral health services will have consistency.

OHA convened the collaborative last summer. The 50-member group includes representatives from peer support services, advocates, counties, behavioral health providers, courts, DHS, CCOs, hospitals, education, law enforcement and representatives from an Oregon Tribe and an urban Indian organization.

The collaborative in March released the Behavioral Health Collaborative Report, which includes recommendations, and a mapping tool that displays interactive information about the state’s behavioral health system.

The workgroups began meeting in May and will end in August.

The Governance and Finance Workgroup, a workgroup of the Oregon Health Policy Board, is responsible for:

  • Developing guidelines for the development of a single-point of shared accountability;
  • Developing guidelines for approval of single plans of shared accountability;
  • Identifying the need for OAR (Oregon Administrative Rules) and contract changes; and
  • Recommending a financial incentive structure.

The Standards of Care and Competencies Workgroup is facilitated through the Behavioral Health Planner of the Addictions and Mental Health Planning and Advisory Council. This group is responsible for:

  • Establishing core competencies;
  • Recommending minimum standards for care; and
  • Recommending mechanisms for co-management of individuals who require specialty behavioral health care.

The Peer Delivered Services Workgroup is a subcommittee of the Peer Delivered Services (PDS) Core Team. This group is responsible for:

  • Developing standards, expectations, and monitoring guidelines for PDS;
  • Recommending a standardized training model; and
  • Recommending certification for peer supervisors.

The Workforce Workgroup is facilitated through the Behavioral Health Planner of the Addictions and Mental Health Planning and Advisory Council. This group is responsible for recommending standards for a well-trained behavioral health workforce.

The Health Information Technology Oversight Council, a workgroup of the Oregon Health Policy Board, is responsible for recommending how to use technology to integrate care across the behavioral health system.


New reports on hospital performance, finances and payments

New reports show the financial condition of Oregon hospitals in 2016, along with their performance on key quality measures. According to these reports:

  • Overall margins for 2016 continue to remain higher than typically observed before the implementation of the Affordable Care Act (ACA). 
  • Net patient revenue increased and charity care remained low in 2016 after a sharp drop from 2013 to 2014.
  • The fourth quarter of 2016 was financially turbulent for hospitals with lower operating and total margins.

Overall, Oregon hospitals remain financially stable. 

Hospital Financials Report

OHA requires 28 large “DRG” hospitals to submit data on 11 measures or “metrics” that include goals such as reducing health care-associated infections, reducing readmissions of patients after discharge, improving medication safety, improving overall patient experience, and screening for alcohol and substance use. In 2016, hospitals showed improvement on adverse drug events due to opioids, reduced central line-associated blood stream infections (CLABSI) and coordination on patient care with CCOs.

In addition, OHA released the Oregon Hospital Payment Report 2015. The report details the median amounts paid by commercial insurers for the most common inpatient and outpatient procedures that were performed in Oregon hospitals in 2015, as required by SB 900.

  • Most procedures show sizable variations in paid amounts, both within and between hospitals.
  • Among common outpatient procedures, heart electrophysiology studies were reported to have the highest median paid amount at $36,900.
  • Among common inpatient procedures, heart valve replacement surgeries were reported to have the highest median paid amount at $84,700.
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Federal health reform remains in flux

Reports from Washington, D.C. about Senate efforts to repeal and replace the Affordable Care Act (ACA) remain fluid. Senate leaders indicate they will vote early the week of Jul. 24. What proposals the Senate will vote on remains uncertain.

This week, the Congressional Budget Office (CBO) scored a Senate proposal to repeal the ACA, as well a modified version of the Better Care Reconciliation Act (BCRA). According to the CBO, the repeal-only bill would result in 32 million Americans losing health coverage by 2026. The revised BCRA would result in 22 million Americans losing health coverage.

OHA and the Department of Consumer and Business Services (DCBS) recently analyzed the impact of BCRA on Oregon. Health policy experts and insurance regulators found the Senate ACA “repeal and replace” proposal would:

  • Reduce health coverage: Result in 440,000 Oregonians losing health coverage by 2025.
  • Add costs to the State budget: Shift as much as $6.2 billion in costs from the federal government to the state by 2026.
  • Reduce jobs: Put as many as 35,000 health care jobs at risk across Oregon.

Thank you Lori Coyner!

Lori Coyner

Lori Coyner, state Medicaid director, has left OHA. She plans to take some time off and explore new opportunities into health care. As state Medicaid director for the past two years, Lori played a central role in Oregon’s ongoing health transformation. She successfully led Oregon’s Section 1115 Medicaid waiver renewal, oversaw the resetting of actuarially sound and federally approved CCO rates, and played a major role in addressing recent OHP budget challenges.

Director Lynne Saxton said, "We’ll miss Lori’s knowledge, energy and considerable skills." David Simnitt will step into the role of interim state Medicaid director.