Kaiser-Trillium Partnership  |  Diane Lund  |  Specialty pharma costs

Transparency is gaining steam in Oregon health care this month, a topic that can become oddly divisive in health policy discussion. We’re watching transparency this month, but we’re also looking ahead to market activity in Lane County and decisions at the Supreme Court.

So, here are 5 Things We’re Watching in Oregon health care in April.  Thanks for reading.

DJ 5 Things Signature

1. Kaiser and Trillium hold hands

In 2014, Kaiser announced it was moving into Lane County.  The move aggravated an already complex relationship with PeaceHealth, which had been complaining to former Gov. Kitzhaber directly about Kaiser’s limited engagement in Medicaid.

Which is why, in part, the news of a partnership between Kaiser and Trillium struck us as interesting. Trillium’s capacity for new patients was stressed after expansion, so the relationship will help them.  But, with Centene moving into that market through the acquisition of Trillium, it strikes us that Lane County could potentially become one of the more dynamic markets of the state in the months ahead.


2. What King v. Burwell means for tax subsidies

With the first round of oral arguments complete, the Supreme Court case that could end tax subsidies will likely be decided in June at the end of the Court’s term. For Oregon, King v. Burwell has special implications. Back when state legislators met to talk about the dissolution of CoverOregon, Senator Brian Boquist (R-12) brought up the troubling reality of Oregon losing some $116 million in tax subsidies, with $988 million in losses projected by 2019, if the decision went sideways.

Today, Oregon is classified a “federally-supported state-based marketplace.” What a ruling for the plaintiff in King v. Burwell would mean for its tax subsidies is not as clear.  While the State has to say it operates a state-based exchange, this appears to be a very muddy area for Oregon, no matter what DCBS says.


3. VIDEO: Diane Lund-Muzikant, The Lund  Report

In our ongoing video series “What They’re Watching,” we feature Diane Lund-Muzikant, Editor-in-Chief of The Lund Report. Lund is sometimes a controversial figure in Oregon health care, but we also often hear folks (quietly) comment to us about how they appreciate her work.  We interviewed her at length last year.  The transcript is a good read.

This time around, Lund-Muzikant highlights the need for financial transparency in Oregon’s Coordinated Care Organizations. She raises a few questions and makes a call for more accountability.


4. Big changes for health plan rate reviews

House Bill 2605A will hold the Division of Insurance to stricter standards of transparency and speed when it comes to how it reviews health plan rates. After a great deal of stakeholder work, legislators have drafted an engrossed bill which gives the Commissioner ten days after a public comment period to approve or disapprove an insurer’s rate filing. If the insurer is not happy with the decision, it can appeal, giving the Division 30 days to respond.

In the world of rates review, this is lightning fast turnaround!  Moda testified in opposition on some of the technical details, but seemed to be a lone voice.  That said, when it comes to greater transparency and public review of rates, one never knows what could happen at the last minute.

5. Specialty drug prices targeted in bills

Specialty pharmaceutical drug prices are a focus of policy makers in Salem.  A recent OSU/OHSU report has brought some new energy to the discussion, with legislation in tow.

HB 2026 would allow the substitution of “biosimilar products” (sort of like generics) for more costly specialty drugs. HB 3486 would mandate that manufacturers with products that cost more than $10,000 per treatment justify their costs annually with the OHA. Finally, HB 2951 would cap all drug copays and coinsurances at $100 per 30-day supply.  Pharma threatened that such transparency measures on pricing could force them to stop selling products in Oregon.