Search
Our Expertise

Our Expertise

We are viewed as experts — in public affairs, media relations, research and lobbying. Find out why. Click here.

Entries in health care reform (21)

Tuesday
Apr292014

Kitzhaber Keeps Pressing Health Care Reforms

Governor Kitzhaber and Kaiser CEO Bernard Tyson agree the health care business model is broken and one major reason why is the separation of care for physical and mental illnesses.

Appearing together at the Portland Business Alliance's annual breakfast, Kitzhaber and Tyson stressed the need to move from a "volume-driven" approach to a model that offers better care at more affordable prices.

The Portland Business Journal quoted Tyson as saying, "There is a mental health challenge we're working on, how to reattach the head to the body." Tyson said physical and mental illness is treated in separate locations, using separate records, even though 45 percent of physical health visits indicate a need for mental health services.

Tyson also said fee-for-service medicine needs to be "thrown out the window."

Kitzhaber touted the benefits being achieved through coordinated care organizations, which he credited for shrinking annual cost increases in care from 5.4 percent to 3.4 percent. The governor noted the 16 current CCOs care for 900,000 lower income Oregonians and are engaged in integrating physical, mental and dental care. He said he next wants to expand CCO cover to public employees and teachers and ultimately to the entire health insurance market.

Click to read more ...

Friday
Feb222013

Kitzhaber Makes National Waves

Governor Kitzhaber went from a face in the crowd in the First Lady's State of the Union box to a news media headliner talking about Oregon's bold venture into transforming the health care delivery system to deliver better quality at less cost.

The former emergency room physician told national audiences this week he couldn't accept budget cuts that forced low-income and working poor families to access their health care in the ER. He told The Washington Post he still vividly recalls an elderly man who was culled for budgetary reasons from the state's Medicaid rolls, but who showed up at his emergency room after suffering a stroke. "These people don't disappear," Kitzhaber said.

Appearing on NPR's Here and Now show, Oregon's third-term governor explained the approach the state is pioneering to "bend the cost curve" of health care by creating incentives to keep people healthy rather than just treat them when they are sick. 

Kitzhaber focused on the care of patients with chronic illnesses who can avoid hospital admissions and additional prescription drugs through more personalized care, often in the form of a Registered Nurse. He said helping to manage chronic illnesses can result in better outcomes for patients and drastic reductions in medical costs. Another cost driver is untreated mental illness, which can result in frequent, costly medical incidents that are treated, but without getting to their root cause.

Click to read more ...

Tuesday
Feb122013

The Governor as Prop

Governor Kitzhaber will be sitting in First Lady Michelle Obama's box tonight as the President delivers his State of the Union Address. Kitzhaber's presence will be highlighted on national television when Obama talks about health care and Medicaid reform.

While in the role of a prop tonight, Kitzhaber has been anything but inert in pushing for health care transformation. His energy for health care reform, early adoption of the health insurance exchange and his push for changes in the health care delivery system have thrust Oregon to the forefront. His ideas for change have won widespread support among health care providers and insurers, business leaders and legislators on both sides of the political aisle.

Perhaps the most fundamental change Kitzhaber is pushing is a system of coordinated care organizations through the state that are charged with improving patient outcomes while reducing costs. Early efforts are aimed at problems such as treatment of complex, chronic diseases to avoid unnecessary hospitalization or prescription drugs.

Oregonians are too often reflected nationally by the shenanigans of Tonya Harding or the caricatures of the televised comedy, Portlandia. We may not know how to act when Oregon is singled out for praise in such a high-profile moment.

Kitzhaber will be joined in the First Lady's box by a teacher from Sandy Hook Elementary, a police officer who responded to the massacre at a Sikh temple in Wisconsin and the parents of a girl killed by gunfire in Chicago, just days after she participated in Obama's inauguration. They will be reminders of the collateral damage of gun violence in America and symbols of why Obama is asking Congress to act on gun control.

Click to read more ...

Monday
Dec172012

Reforms Will Push Up Premiums

Implementation of health care reforms in Oregon and America are beginning, but may occur in the backdraft of rising insurance premium rate shock.At the end of the 2011 and 2012 legislative sessions, headlines crowed about the progress Oregon had made on health care transformation as a result of bipartisan legislation from both sessions. In fact, Oregon has become a national leader on the topic with leadership from Oregon's governor, Dr. John Kitzhaber. From the establishment of Coordinated Care Organizations (CCOs) to the establishment of one of the first exchanges nationwide, Oregon took major steps forward in implementing health care reform.

As CCOs have begun to spring up in different communities throughout the state and details of the health insurance exchange have become more clear, a surprise that legislators didn’t anticipate is beginning to bubble-up to the surface: Major increases in health care costs will hit consumers just as the exchange debuts early next year.

Many of the causes of these cost increases are outside the control of Oregon legislators, but they nonetheless have the potential to unravel public support for reform as front-line consumers come face-to-face with the true cost of health care for the first time. 

Click to read more ...

Wednesday
Oct242012

Banking on Health Care Coordination 

A lot rides on the success of health reform ventures such as coordinated care organizations (CCOs), but not everybody knows what they are, including some of the people responsible for making them happen.

The Oregon Business Association honored 11 Oregonians this year for their contributions to CCOs, which are just being formed after winning legislative approval in 2011. One of the honorees said the task of CCOs is to fill in the white spaces between existing parts of the health care delivery system.

Senator Alan Bates, D-Ashland, talked about filling in the white spaces to ensure greater coordination in delivering health care services to improve patient outcomes and save money. He gave an example of a man who underwent extensive medical treatment for physical ailments, while his underlying psychological issues weren't diagnosed or addressed.

CCOs call for unprecedented levels of coordination between health care providers that are competitors. People seem to be playing well in the sandbox together now, but how it ultimately works out remains unknown.

Just as important is whether CCOs can help stem the tide of rising medical costs for low-income Oregonians as budget pressures build at the state and federal levels to find cuts in Medicaid and Medicare.

The predecessor term to CCOs — accountable care organizations — was first used in 2006 by Elliott Fisher, Director of the Center for Health Policy Research at Dartmouth Medical School, during a discussion at a public meeting of the Medicare Payment Advisory Commission. The term quickly gained credibility, reaching its pinnacle in 2009 when it was included in the federal Patient Protection and Affordable Care Act.  

Click to read more ...

Friday
Jun292012

What Does Health Care Ruling Mean to Oregon?

There are probably as many interpretations as there are analysts looking at the words that Chief Justice John Roberts wrote for the Supreme Court in a historic 5-4 decision upholding major provisions of the Affordable Care Act.

It is tempting to delay comment because so much of what this landmark ruling means will play out over time, both in Washington, D.C. and around the country in states such as Oregon, where Governor John Kitzhaber has taken the lead in implementing reform measures.

Still, here are a few perceptions:

         *  Regardless of how the Court ruled, Oregon was committed to proceed with a number of reforms that emerged from the last two Oregon legislative sessions. That includes the governor's proposal to create Coordinated Care Organizations (CCOs) as mostly non-profit entities to handle the task of organizing and delivering Medicaid services to low-income Oregonians.

         From the governor's standpoint, the new CCOs — eight of which were approved this week to begin operating August 1 and a number of others are in the queue for a later start — will manage Medicaid closer to where people live, prompt providers to collaborate with each other for the benefit of patients and place a great emphasis on prevention, all (at least in theory) to save money.

         If money gets tighter and the CCO reforms don't work, the tough decisions — cutting recipients off Medicaid, cutting back on benefits or cutting provider reimbursements — will fall into the laps of regional or local CCO directors. In the past, these decisions would have been made on the Capitol Mall.

         *  The ruling does retain momentum toward the day, in late 2013 or early 2014, when Oregonians will have a chance to choose health insurance coverage through an online shopping center called an "insurance exchange."  Oregon already is a long way down the road toward starting its exchange and, arguably, would have continued regardless of how the court ruled. But the endorsement of an individual health insurance purchase mandate means the exchange will have a greater chance to succeed a year or so from now. With a few exceptions, those who now don't buy insurance will have to do so.

Click to read more ...

Monday
Jun112012

Surprise Decision Strains Reform Support

The decision caught almost everyone by surprise last week. The Governor's Office and the Oregon Health Authority said they would not make any of the $2 billion in new federal money obtained by the Administration available for the first year of health care reform in Oregon.

"Members of the new groups (Coordinated Care Organizations, CCOs) are crying foul," reported The Oregonian, "after a directive Thursday that they'll receive no new funds for the additional responsibilities they've agreed to take on — mental health care, prevention efforts, quality measurements and new patient-care staff, among others."

In fact, managers of the new, still-not-yet-approved CCOs have been told they will have to live with last year's rates, which themselves represented an 11 percent cut. Leaders of the new groups say their success relates directly to the new money to fund them. They say it takes money to revamp care for more than 600,000 Oregonians covered by Medicaid, the joint federal-state program that provides care for low-income citizens.

In touting health care reforms such as CCOs and the Health Insurance Exchange, Kitzhaber has stressed the need to control costs through competition and innovation.

For many in the health care reform orbit, all of this conjures up images of the original Oregon Health Plan more than 15 years ago, also designed by Governor Kitzhaber in his earlier service as Oregon Senate President and as governor in his first term. A key tenet of the plan then was that providers would be paid close to their costs for delivering services. The clear objective was to limit the cost shift onto the backs of private health insurance payers.

Well, that tenet apparently has been lost in the intervening years.

Today, those with private health insurance pay about 20 per cent more in premiums as they bear the "hidden tax" of paying for Medicaid underfunding. In a 2008 study, the Milliman Group estimated underfunding of Medicaid and Medicare amounted to more than $90 billion annually.  Though four years old, the study is still applicable today.

Click to read more ...

Monday
May072012

Kitzhaber Brings Home Bacon

The big news last week revolved around Governor Kitzhaber's successful, last-minute trip to Washington, D.C. where he negotiated final terms of a deal that will bring Oregon almost $2 billion in federal money over the next four years to finance health care reform. The first installment — $620 million — is expected to arrive in Oregon by July 1.

As The Oregonian put it in its lead story on the successful trip: "Kitzhaber saves Oregon budget and his reputation in health care deal with Obama Administration." Both points are true. Oregon needs the money to fund reform. And, Kitzhaber, a former emergency room doctor who thinks, lives and breaths health care policy, had almost no choice but to succeed in D.C.

What remains is a question about whether the new federal money can be used to fill budget holes or must be devoted to new health care reforms. But that question, as important as it may be to budget analysts, ignores the basic policy point — the money will go to reform and that will mean that the reforms have a better chance for success here.

Click to read more ...

Friday
Mar232012

Retired Law School Dean Reflects on Ruling

Symeon Symeonides pondered a moment, then said he had no idea how the U.S. Supreme Court would rule on the constitutionality of the Obama health care law, especially the individual mandate requiring every citizen to have health insurance. The high court will hear arguments in the case next week.

An internationally renowned constitutional law scholar, as well as one of Salem's best-kept secrets, Symeonides said it might be easier for states like Oregon to impose a health insurance buying mandate than for the federal government to do so. After all, he said, Massachusetts passed a mandate a few years ago and it appears to be working — though Republican presidential candidate and former Massachusetts governor Mitt Romney would rather kick the issue to the background. 

Symeonides and I, along with Willamette Law School's development director, Mike Bennett, sat down for a drink last week to reflect on the Supreme Court case, which stands to be one of the most significant in years, perhaps even rivaling the abortion or desegregation decisions. It was only about a week before Symeonides headed off to Brussels, where he will be working for several months to advise the European Union on how to draft a new constitution.

If states found the political wherewithal to impose an individual mandate — and Symeonides, ever an astute observer of political winds, thinks that could be a tall order — it might be easier legally because it wouldn't run up against the U.S. Constitution's commerce clause. Under Article 1, the clause gives Congress "the power to regulate commerce with foreign nations and among the several states, as well as Indian tribes."  The outcome of the court case rests, at least in part, on how current justices interpret the commerce clause and whether regulating commerce "among the several states" allows for an individual health insurance mandate.

The New York Times published an article last week, with the headline,  "At Heart of Health Law Clash, a 1942 Case of a Farmer's Wheat."

"If the Obama Administration persuades the Supreme Court to uphold its health care overhaul law, it will be in large part thanks to a 70-year-old precedent involving an Ohio farmer named Roscoe C. Filburn."

Seems that Mr. Filburn sued to overturn a 1938 law that told him how much wheat he could grow on his property and imposed a penalty on him if he grew too much. The Court ruled against Mr. Filburn, and that ruling serves as the pivot for what the justices will begin considering next week. The Times says interpretations of the Filburn case may form the basis for decisions by the two current-day justices who are considered the swing votes in this case, Anthony Kennedy and Antonin Scalia.

Click to read more ...

Monday
Feb062012

Three Down – Only 26 to Go

As legislators headed home Friday to gear up for a second week in Salem, it was difficult for anyone accurately to describe the activities of the first three days because things moved much faster than normal at the Capitol — especially for opening days of a legislative session.

There was a crush of business as committees posted hearings on a large number of bills that probably will go nowhere. It prompted a lot of scurrying around, as lobbyists tried to figure what had a chance of passage and what didn't.

Three major "reforms" proposed by Governor Kitzhaber — education, health care and early learning — began moving down paths toward probable approval later this month. If you were betting, you would say the governor would win, but not without push-back by some Republicans who believe change is moving too fast for anyone to accommodate.

A so-called "budget deal" announced on the second day of the session last Thursday produced a bit of buzz, plus a couple headlines, but no one was sure about the real scope or impact of the deal. It turned out to be a "budget re-balance" plan, which means it represented an attempt by Joint Ways and Means Committee leaders to solve internal problems in the budget that had emerged in the last six months since adjournment last June.

The re-balance plan didn't address the current shortfall in state tax revenue, which has been pegged at about $305 million. Nor did the plan address any new revenue shortfall, which could be announced Wednesday when the state economist releases the latest revenue forecast at a joint meeting of the House and Senate Revenue Committees. It also prompted criticism of the Ways and Means co-chairs who took some of a recent Phillip Morris tobacco tax court-ordered payment — about $56 million — and applied most of it to the general budget deficit, not, as proposed, to funding for crime victims. Such is the stuff of Ways and Means.  Money ostensibly for one purpose is swept for another purpose.

Click to read more ...