5 Things Oregon: Executive moves, US Senate, CCO Metrics

It’s an amazing time to watch the US Senate. Votes continue today with a single payer amendment coming to the floor as I write. But, we’ve got our eye on a few other items in Oregon health care as well.

Here are 5 Things We’re Watching for Oregon health care executives and health policy leaders in July.

DJ 5 Things Signature




1.  Senate votes on reform

The vote Tuesday in the Senate on the motion to proceed to debate was dramatic. Sen. Ron Johnson (R-WI) held out his vote until the last minute. He was followed by comments from Sen. John McCain who stated that the lack of bi-partisanship is hurting the Senate and hurting America.

Debate is underway, but it’s unclear on what senators will be voting tomorrow at the close of debate.  Either way, there is a long road ahead before final passage.  You can watch the proceedings here.  A vote on a single payer amendment comes up at 11:15 today. Roll Call votes are tracked here.

If something can get 51 votes, the bill will go to “Conference Committee” where House and Senate leaders will merge the two chambers’ versions into a new bill.  It’ll likely be something entirely new, and we’ll go through this process once more.

2.  CCO Metrics report is candy for data geeks

The CCO Metrics 2016 Final Report was released recently, and it’s 138 pages of great stuff. The structure of the report, and the data visualization, continue to be best in class among any state effort at quality transparency with which I’m familiar.

It shows the quality payments made to CCOs based on hitting their quality improvement marks. The “quality pool” of payments from premium withholds now equal 4.25% of monthly premiums. Of the 16 CCOs, only 7 received 100% of their quality pool dollars. From the report: “The results from the quality pool model are demonstrating that this is not just another program to pay CCOs for service, but to push CCOs to focus on performance and improving the health outcomes of members.”

Interestingly, in that push for performance, on three measures the “Top performing CCO” did not meet its own individualized improvement target for 2016. That has created a question about how hard to push high performing CCOs.  If a CCO ranks #1 among CCOs, but doesn’t meet their own internal targets as a result of consistent year over year progress relative to other CCOs, should they be dinged financially for missing that individualized target?  It’s an interesting policy question that will likely continue.

3.  Culture, health policy and the session

Every stakeholder I’ve talked to about the 2017 legislative session has said it was a bruising year. That’s perhaps to be expected with such a significant fiscal shortfall in place. But, I think it’s also reflective of what might be an increasing cultural divide between regulator and regulated, between policy makers and the industry.  I outline my thinking here, which builds upon my recent article regarding the “lack of social capital” in Oregon Medicaid.

This cultural gap isn’t going to be fixed soon, and in fact is going to be evidenced through the fall.  Rep. Julie Parrish is building a referral campaign that will put the Medicaid funding package on a January ballot. I’m told she has raised the money needed to fund the signature gatherers, and many stakeholders are assuming the package will be before voters. It’s unclear who might fully fund the campaign, but expect opposition to be well funded.

4. Video: Deborah Rumsey

Deborah Rumsey is the executive director at Children’s Health Alliance, an IPA of pediatricians in the Portland area. She works closely in leading pediatric practices in clinical quality improvement.  Rumsey joins this edition of “What They’re Watching” to talk through how pediatricians can help build resiliency in patients to create “an immunization if you will for adverse childhood experiences.”

“Pediatricians and providers in general are afraid to address something that they can’t solve, but really importantly is laying the groundwork to helping the practice know how do I relate differently to these patients.”

5.  Executive changes in Oregon health care

Lori Coyner has left her role as Oregon’s state Medicaid director after taking the position at the end of 2015. She had worked at the OHA since 2013, developing the sometimes criticized CCO rate-setting methodology. David Simnitt, OHA’s health policy director, has taken on the role until a permanent replacement is found.

Tom Holt is leaving his position as Director of Government Relations for Cambia on August 25th. Holt is one of the most respected government relations professionals in Oregon, having worn multiple hats over the years as a corporate and contract lobbyist.

Meanwhile, at Health Management Administrators, long time CEO David Snodgrass announced he has stepped down. Steve Suter is now the firm’s CEO. Snodgrass launched the firm in 1986, growing into the TPA business to serve employers in the self-funded marketplace. Over time, through mergers and acquisitions which resulted in Cambia acquiring the business, HMA has grown to be one of the largest TPAs in the country with a significant footprint in Oregon.