New conference date | Bundled payments | Learning from Sierra Leone?

The biggest transformation in healthcare this year may have just taken place this month, with CMS starting to make good on it’s move to value-based payments. Oregon’s push towards consensus on quality metrics will support that move, too.

It makes for a big month in Oregon, and some of what we’re watching in Oregon health care this month.

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1.  Heads up: New date for State of Reform conference

Interest in our 2015 Oregon State of Reform Health Policy Conference is at an all-time high. Our Topical Agenda is out, and spots on our speaker panels are filling up. For those of you marking your calendars, we’d like to draw your attention to a change.

This month, the legislature released their fall committee days making our original conference date difficult for some of our key attendees who would be tied up in Salem. To ensure the kind of excellent health policy event you’ve come to expect, we have moved our date to Tuesday, September 15th.  We hope to see you there!


2.  Pricing the individual, small group markets

Moda recently received 65% of all of Oregon’s reinsurance dollars under the ACA, a function of high claims against a relatively low premium. But, while Moda drew down the most dollars, statewide Oregon drew down 2.1% of all reinsurance dollars in the US. Oregon’s population is only 1.2% of the national population.

This highlights the difficulty of pricing this new and fluid market. The State reinforced the point by approving higher average rates for 2016 for 8 carriers than the carriers had submitted. Commissioner Laura Cali even raised the possibility of carriers leaving the market mid-year with otherwise “inadequate rates.”


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3.  OHA plans statewide health metrics change

Perhaps the most impactful piece of legislation in this year’s session is SB 440. The measure mandates that the state standardize health care quality metrics across CCOs, employers, and agencies by 2018. It’s got Lynne Saxton and her staff at the Oregon Health Authority hustling to devise a time line and work plan by the year’s end.

With CCOs, counties, and hospital systems still speaking their own language when it comes to quality measures and what is meaningful, the lift is huge. But, like the prioritized list, a consensus around what is meaningful for measuring systemic performance could powerful and long standing.


4.  ‘The biggest thing in health care this year’

CMS’s announcement that it will make bundled payments to hospitals for hip and knee replacement might be “the most significant thing that’s happened in health care all year.”  The Portland metro area is one of the 72 regions which will undergo this change.

This change is likely to challenge hospitals and skilled nursing facilities first, but it could also pre-sage the end of the CPT/DRG system of payment launched by Medicare in 1983. It was that change, some argue, that built a mechanism for our extreme cost inflation since that time. But, with CMS saying it wants 85% of payments on a value-based model by 2016, we should expect more of this.


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5.  You know it’s bad when…

Politico, based in Washington DC, puts out a daily email on federal agency rules and Congressional action. In a recent edition, they made the suggestion that the US health system can learn from…. wait for it… Ethiopia. They went on to add Rwanda, Uganda and Sierra Leone.

It’s just one anecdotal data point, so I don’t want to overstate it.  But, when a smart outlet like this one implies the US health system is so bad we can learn from Sierra Leone, it’s probably a sign things are worse in US health care than even I will let myself believe.