5 Things Oregon: CCO 2018 rates, SUD research committee, Laura McKeane

DJ is on a (much needed) vacation, so he left me the keys for this edition of 5 Things We’re Watching. Emily Boerger on our team is pitching in. Normally, I’m reporting on health policy or producing our podcasts.

Anyway, enough about me.  On to What We’re Watching in Oregon health care and health policy for November.

Kylie Walsh

1.  CCO rates and FamilyCare

After OHA released the 2018 CCO reimbursement rates last week, FamilyCare says its rate increase isn’t enough and will likely produce a $75 million deficit and force it out of business by August. FamilyCare received a 9.8 percent rate increase, while the rest of the CCOs received an average rate hike of 3.3 percent. However, even with the largest rate hike, FamilyCare still has the second lowest per-member payment rate ($377.57 per member per month). 

FamilyCare has filed lawsuits against the OHA over its rate-setting process over the past few years and its 2017 lawsuit is set to head to trial on February 5. They have yet to announce specific actions they might take in response to the announced 2018 rates. 

OHA says the rates are actuarially sound and they will conduct two additional reviews, by another Medicaid-qualified actuary and an independent law firm, before they send the rates to CMS for approval. The results of these reviews should be released later this month.

2.  Substance Use Disorder Research Committee releases recommendations

The Oregon Substance Use Disorder Research Committee (OrSUD) released a report this morning outlining recommendations for addressing Oregon’s opioid and substance use disorder (SUD) crisis.

According to the report, approximately 1-in-10 Oregonians suffer from SUD and only 11 percent of those people receive treatment. Last year, approximately 1,500 people died in Oregon from alcohol-related causes, and in 2015, 505 Oregonians died from drug overdoses. The financial cost of SUD in Oregon is as much as $6 billion every year.

Samuel Metz, co-chair of OrSUD and corresponding author of the report wrote an op-ed for State of Reform about the difficulties of combating SUD and the steps Oregon needs to take in terms of both prevention and treatment services.

3.  Podcasts: Democrat and Republican Policy Leadership

If you weren’t able to join us at our recent conference in Portland, we have some additional content from the event to share with you. We hosted two health care legislative leadership panels, which gave some insight on the last legislative session and where we can expect the legislature to go next.

Senator Laurie Monnes Anderson and Representatives Mitch Greenlick and Rob Nosse spoke on the Democrat panel. On the Republican panel, we heard from Senator Tim Knopp and Representatives Cedric Hayden and Ron Noble.

Take a listen and make sure to subscribe to us on iTunesSoundCloudStitcher, wherever you listen to podcasts so that you’re notified as soon as we release new content.

4. Oregon Waivers

CMS approved Oregon’s 1332 State Innovation Waiver at the end of last month, providing Oregon an estimated $30 million a year to fund the Oregon Reinsurance Program. Oregon’s claims-based program is different from Alaska’s condition-based program, but both have already succeed in driving down premium costs for 2018, with Oregon premiums reduced by 6 percent .

But a draft memo from CMS Administrator Seema Verma to HHS leadership has threatened 1115 waiver funds, according to Politico. Oregon funding was specifically mentioned in the story. It’s unclear if the memo refers to existing waiver funds, but pulling those funds would likely lead to lawsuits against the federal government from multiple states. Oregon’s Medicaid Demonstration waiver renewal began at the start of this year and runs through 2022.

Plus 1:  People on the move

I wanted to flag a few staffing changes for you. First, Ruth Brinkley was named the new president of the Kaiser Foundation Health Plan and Hospitals of the Northwest. Ruth comes from KentuckyOne Health, the state’s largest integrated health system, where she has served as CEO since 2013.

Second, Michael Becker has joined PacificSource Health Plans as Vice President of Government Relations. Previously, Michael served as Associate Vice President of state government affairs for Providence St. Joseph Health.

Tom Holt was formerly Director of Government Affairs for Cambia, but he’s put out his own shingle under the name The Holt Company.  He’ll be doing government relations and strategy work in Salem for clients.

5.  Video: Laura McKeane

When you hear “integration” you probably think of behavioral and physical health. Not for Laura McKeane, who joins us in this edition of “What They’re Watching.  She’s talking about integrating oral health into the primary care setting. Laura is AllCare Health’s Oral Health Integration Manager, and she’s done a considerable amount of work in ensuring kids have access to oral health care before they even get to the dentist’s office.

“I have trained probably 250 providers to do oral health assessments and apply fluoride varnish in the pediatric setting. And the reason we do this is we’re really passionate about getting the fluoride on the kids in the pediatric setting because they don’t go to the dentist, the kid’s that little. So if we can get that fluoride on and get them that base, that’s what we want to do.”