5 Things We’re Watching – Oregon, November 2013

There is rightfully a lot of news and interest in Cover Oregon.  The implications for its lack of success are multi-fold to consumers and plans alike.

But, that’s balanced this month by intriguing and exciting data:  some from JAMA on costs, and some from the OHA on CCOs.  So, it’s important to keep our eyes on the horizon.  Things are changing in health care.  And, I think one lesson amidst the noise is that we’re all dependent on one another for our success.

DJ Wilson - Host, State of Reform

1. Cover Oregon: Maybe Dec 15th?  Maybe…?

The Cover Oregon story continues to, well, shock.  It’s one thing to be called “worse than healthcare.gov” – in itself a tremendous blow.  But, to tell the legislature the site may not be up until after open enrollment is over March 31?  That’s really something.

Now, I’m betting Rocky King is trying to manage expectations by setting a low bar.  He’s done that before with some success (see item 1) at the time.  He also said the site could be running by Dec 15th.  But, as one person told us, “They’ve just lost the trust we put in them, and the pride we took as Oregonians in their work.”  That goodwill is hard to get back, even with a low bar.

2. Collateral damage from Cover Oregon

Consumers who are unable to get coverage through the exchange, and who also hold cancelled plans from their existing carrier, were one of the groups drawing considerable concern by legislators yesterday – a story that’s drawn even President Obama’s attention.

But what about those health plans that invested in product development for the exchange?  We asked Ralph Prows, CEO of Oregon’s Health Co-Op, to talk with us about the impacts on his business with Cover Oregon still not operational.  It’s a story that’s not getting enough attention, we think (hint, hint PBJ).

Family care

3. ‘65% from 65 and under’

Last week, JAMA released perhaps the most important study we’ve read on health costs in years.  It overturns some mainstream notions about costs in American healthcare.

84% of costs in American health care today come from chronic conditions from the entire population, not just the elderly.  In fact, 65% of all costs in American health care today come from chronic conditions from people under the age of 65.

Since 2000, personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%.  Price is 91% of the increase in costs, not utilization or service intensity.

4. Is Oregon health policy about to become ‘the’ political issue of 2014?   

Oregon politics is generally not a breathless, “Crossfire”-style activity.  Some folks have worked for years to keep health policy a non-partisan issue.

Given the lessons of some recent elections, however, it seems one lesson championed by US Rep Greg Walden is for Republicans to give voice to the frustration of voters with the ACA roll out.  That would represent a relatively rightward shift in Oregon on health policy if that were to happen, and a potential wedge issue in 2014.

It’s unclear if that will impact the governor’s race, but it seems Jeff Merkley is paying attention ahead of his 2014 re-election bid to the Senate.


5.  The data on CCOs is out, but only part of the story

The early numbers from the CCO project are good – more than good, really.  As Bruce Goldberg presented yesterday in Salem, and which were released in Executive Summary form a few weeks ago, since January hospital admissions are down 12%, primary care visits are up 18% (though primary care costs are up only 6.5%), and enrollment in patient-centered medical home models is up from 51% to 71%.

That’s powerful stuff.  But the real magic is happening at the table between providers.  We’re hearing stories of some providers getting paid 3x as much as providers in the same CCO for the same service – and they had no idea that was the case before.  The importance of the model, we think, is this new accountability to one another within a medical community.  Instead of justifying their reimbursement to Salem or plans, they have to do it with one another.  And, that is really powerful stuff…