5 Things Oregon: CCO 2.0, session recap, opioids

Kylie Walsh and Emily Boerger on our team continue to do great work helping me with reporting and analysis at State of Reform.  Both help craft this newsletter for you each month, which I appreciate.

Also, save the date for our annual fall conference. Our 2018 Oregon State of Reform Health Policy Conference is coming up on October 16th. That said, here are 5 Things We’re Watching in Oregon health care for March, 2018.

DJ 5 Things Signature

1.  Bills that moved in the session

The legislative session ended earlier this month with the passage of several health policy bills. The CCO Transparency bill passed after receiving support from the CCOs, making governing board meetings open to the public. The Prescription Drug Price Transparency bill also passed, but with strong opposition from the pharmaceutical industry including PhRMA.

The legislature also made progress on addressing substance abuse disorders, clarifying financial assistance options, and updating Oregon’s advance directive forms.

2.  OHA building a vision for CCO 2.0 procurement

The OHA has released a stakeholder feedback schedule to hear from interested parties related to the next CCO procurement.  They are referring to the model as “CCO 2.0,” an aspirational framework seeking to build on the last 5 years of work and learning.  From the plan:  “We now have more than five years of experience with the CCO model and lots of data about what is working and what needs more work over the next five years.”  The plan includes a web surveyand a series of public meetings to be held across the state.

More importantly, they’ve included a set of “proposed work plans” on a range of key areas of focus.  The plan on “value-based payment” asks whether CCOs should be offered incentives for VBP models that effectively address behavioral health needs or social determinants, both of which have their own work plans.  Final reports on stakeholder input, including a review of all stakeholder work since 2013, are due on May 25th.  The Oregon Health Policy Board are expected to adopt final recommendations in August.

3.  Video: Mike Rohwer, Curandi

Dr. Mike Rohwer is a physician, thought leader, and the Executive Director of Curandi, a membership organization dedicated to reforming the healthcare system. He joins us in this edition of “What They’re Watching” to talk about applying system science to healthcare.

“Curandi is a membership organization dedicated to advancing 21st century systems science in health care. And basically, what that means is that we use more complex networks in order to serve the patients. Putting the patients at the center of care using networks that adapt around every point of care to deliver what they need. That sounds a little abstract but it’s necessary in order to be able to match all the variety of changes that come out of a complex problem like health care.”

4.  Hospitals face sliding operating margins

Apprise Health Insights, a subsidiary of the Oregon Association of Hospitals and Health Systems (OAHHS) has released its Q4 2017 Hospital Utilization and Financial Analysis. The report showsthat operating margins continue to decrease while charity care increases. Outpatient visits have increased sharply while inpatient discharges continue to decrease. Medicaid Payer Mix continues to decrease while Medicare Payer Mix continues to increase.

These trends are accurate for hospitals across the state, large or small, urban or rural, and system or standalone. Andy Van Pelt, executive VP of OAHHS said in response “We know that costs have risen compared to revenues, but other factors are also at play. With this outlook, it’s more important than ever that policymakers and hospitals work collaboratively to ensure the financial soundness of the health care system in Oregon.”

5.  Opioids in photos; Gov. Brown testifies on opioids before US Senate

If you haven’t see Time’s recent photojournalism showing what the opioid epidemic looks like in America, it’s worth your time. It’s powerful. “If there was a terrorist that showed up…and shot 50 people or 25 or 10 for that matter, this community would be in an uproar. There would be an army here trying to stop it. That’s exactly where we are with opioids. But who’s showing up to stop it?”

Notably, while the US has had a 14% increase in overdose deaths, Oregon has seen a 3.7% decrease. Governor Brown testified earlier this month to the US Senate HELP Committee on the opioid epidemic, where she shared some of Oregon’s successes in responding to the crisis.

“In Oregon, I will soon declare addiction and substance abuse to be a public health crisis, in no small part because of the impacts of opioids. We have seen a 400 percent increase in opioid use disorder over a ten year period ending in 2015. Roughly one in ten of our young adults aged 18 to 25 have abused opioids. Every other day, on average, we lose one more Oregonian due to an opioid overdose.”