Providence resignation | High provider prices | Jeff Heatherington

Expect news in the next week on a major financing proposal to close the Medicaid budget gap in Salem – which is among the most important health policy issues in Oregon this year.  But, until then, we’ve got 5 Things We’re Watching in Oregon health care for the month of February for you.

1.  Providence stories lead to resignation

The Seattle Times just printed two of the most powerfully damning stories I’ve ever read about the health care system with Providence and its affiliate Swedish as central figures in the stories.  You should read them both (one, two).  They are part of a new investigative series by the Times on how the financial incentives in health care can corrupt a system – from care delivery to administration. This comes on the heels of similarly awkward reporting from Anchorage on Prov “getting rich” there.

This week, Swedish’s CEO Tony Armada resigned as a result of the investigation, but not before saying the stories were based on “rumor and misinformation.” Legislators are now calling for a new investigation into Providence’s practices, as well as a review of any harm done to Medicaid beneficiaries at Prov. Meanwhile, a neurosurgeon in Texas just received life in prison – for similar practices employed by Prov neurosurgeons as detailed by the Times.

Charity

2.  Video:  Jeff Heatherington

“Unwavering.” That’s how Greg Van Pelt of the OHLC described Jeff Heatherington at a recent breakfast event. Both Jeff’s friends and otherwise would likely agree with the sentiment.

In this edition of “What They’re Watching,” Jeff levies some criticism about the OHA. These comments were made during our September annual event, so they were made ahead of the waiver’s recent approval from CMS. But despite the friendliness while sharing the stage with Lynne Saxton this week, the fiscal pressures in Salem are likely to continue to exacerbate relations between the OHA and at least some of its CCO partners.

3.  Medicaid enrollment backlog at OHA

Enrollment in the Oregon Health Plan is down about 11% since last March, a number that is having some significant impact on CCO financial performance at the same time the legislature is talking about cuts to CCO premiums.  We explore some of the reasons for the decline here, but stakeholders are telling us they think the reason is clear:  operational problems at the OHA.

I asked the OHA for some insight but haven’t gotten a response. One stakeholder told me this was to be expected even if it wasn’t acceptable in their eyes. “We recognize the need for greater transparency around outcomes in the delivery and financing of Medicaid. Shouldn’t we expect the same transparency out of the OHA so that we can all be more successful in this endeavor?”

4. Oregon prices for care higher than comps

A recent Oregon Health Care Quality Corporation (Q Corp) report looked at cost and utilization across five regional markets (Oregon, Utah, Maryland, St. Louis and Minnesota). The report showed that Oregon health care utilization is lower than in the other regions but average prices are the highest—17% above the regional average (and 25% higher for inpatient).

If the two regions with the highest cost per participant (Oregon and Minnesota) were to reduce their spending as little as 2.5% ($9 per member per month off of $354 PMPM in Oregon) employers and private purchasers would save $200 million annually in health care spending.  Consumers would also see a reduction in out of pocket cost.

5. Shaping the future of CCOs

The Dean of Oregon health policy, Rep. Mitch Greenlick, has a bill (HB 2122) that would reshape CCO governance. It would force CCOs, among other things, to be non-profit organizations, and make all of their board meetings open to the public. This builds on work conducted by the Oregon Health Policy Board during the interim period. Their recent report from “listening sessions” included a number of critical comments from the community.

Some reflected consumer concerns:  “Why aren’t CCOs able to process an address change?? We were on hold for 50 minutes with the OHA and then told they couldn’t process the name change.” Others might be considered more ‘inside baseball’: “It has been horrific! Our CCO refuses to offer APM, or VBPs!”