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The 2011 overhaul of the low-income Oregon Health Plan made progress, but job not done, study says

TRIBUNE FILE PHOTO - Patrick Allen, director of the agency overseeing the Oregon Health Plan, says he is encouraged by a new, mixed review of five-year-old reforms intended to improve care and save money.Reforms to the Oregon Health Plan appear to have saved money and improved care, but there's more work to be done, a new report says.

The findings come at a time when about one in four Oregonians receive care under the government-funded low-income health program, and the agency overseeing it has been under fire from Republicans, notably gubernatorial candidate Knute Buehler, a Bend lawmaker.

Voters affirmed health care taxes supporting the Oregon Health Plan earlier this week by overwhelmingly passing Measure 101.

The new report found that the overhaul of the Medicaid-funded program spearheaded five years ago by former Gov. John Kitzhaber spawned significant progress in some aspects, but are lacking in key areas.

On the plus side, the state has successfully set up the system mandated in the 2011 reform legislation, centered on regionally based coordinated care organizations — which function much like health insurers, managing networks of doctors and other providers to provide care. The groups are given a slice of funding and leeway on how to spend it, while reporting back on a series of state-approved benchmarks intended to ensure quality of care.

That said, major portions of the reforms are not yet a reality. The major payment reforms envisioned to streamline care and reward health rather than merely pay for care have only begun to be adopted, according to the report. Meanwhile integration of different aspects of care — physical, dental and behavioral — is behind schedule.

The study was required by the federal government and prepared by researchers for a think tank at the Oregon Health & Science University called the Center for Health Systems Effectiveness. The state funded the work under a $350,000 agreement with OHSU.

Asked what portion of the reforms envisioned have become reality, John McConnell, Ph.D., the center's director, responded "I'd say it's probably somehwere in the 60 to 70 percent range." As far as integrating care, "I'd say the integration efforts were slower than people hoped.

He called Oregon's ability to slow the rate of spending growth "an important but elusive goal for most health systems."

He said the next five years would be a significant test of whether the CCOs thrive, adding that federal or state reforms will be needed to address high drug prices. He said the Oregon system "may be well suited to address these issues over the next five years."

The federal government provides a majority of the funding for the Oregon Health Plan but the state chips in a significant portion as well, which drove the Measure 101 fight.

The state reforms kicked in even as an expansion mandated under the federal Patient Protection and Affordable Care Act flooded the system with billions in additional federal funds as well as nearly 400,000 newly eligible members.

Researchers found that in Washington state, which did not embrace reforms like Oregon's, costs for medical care provided at hospitals and other care facilities went up at a significantly higher rate.

Click here to download report.

"This report shows that we have kept our commitment to keep costs down and we've set up the infrastructure to transform the health care system in Oregon. We have more work to do, and the report gives us a roadmap and suggestions for building on what we've already accomplished," said OHA Director Patrick Allen in a statement.

The report recommends beefing up the system of benchmarks and incentives to ensure quality of care, while also requiring more detailed reporting from care organizations.

Nick Budnick
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