Oregon Health Authority Health Policy & Analytics Presented to - - PowerPoint PPT Presentation

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Oregon Health Authority Health Policy & Analytics Presented to - - PowerPoint PPT Presentation

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Oregon Health Authority Health Policy & Analytics Presented to Joint Committee on Ways and Means Subcommittee on Human Services March 6, 2019 Patrick Allen, Oregon Health Authority Director Jeremy Vandehey, Health Policy and Analytics

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Oregon Health Authority Health Policy & Analytics

Presented to Joint Committee on Ways and Means Subcommittee on Human Services March 6, 2019 Patrick Allen, Oregon Health Authority Director Jeremy Vandehey, Health Policy and Analytics Division Director

  • Dr. Dana Hargunani, Chief Medical Officer
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OREGON HEALTH AUTHORITY Health Policy & Analytics

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Why HPA

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Health Care as a Percentage of Household Spending Continues to Increase

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OREGON HEALTH AUTHORITY Health Policy & Analytics

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If Food Were Health Care…

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Institute Of Medicine: $750 Billion in Annual Waste in the Health Care System

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$206 billion $186 billion $128 billion $103 billion $74 billion $54 billion

Unnecessary services Excess administrative costs Inefficient care delivery Inflated prices Fraud Prevention failures

Source: Brian Fund, “How the U.S. Health-Care System Wastes $750 Billion Annually,” The Atlantic, September 7, 2012.

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$56 $57 $58 $38 $35 $34 $36 $41 $28 $26

2011 2012 2013 2014 2015 Oregon Washington

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CCOs Have Reduced Costs

Inpatient facility spending decreased in both Oregon and Washington, but decreased much more among CCO members

OREGON HEALTH AUTHORITY Health Policy & Analytics

Inpatient facility spending, per member per month

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What HPA Does

OREGON HEALTH AUTHORITY Health Policy & Analytics

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HPA’s Goal is to Transform and Improve Oregon’s Health Systems for Everyone

OREGON HEALTH AUTHORITY Health Policy & Analytics

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Oregon is at the Cutting Edge of Health Care Reform Efforts

OREGON HEALTH AUTHORITY Health Policy & Analytics

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Innovations in Public Programs Can Influence Other Markets

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Strategies and Successes

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HPA Organization

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HPA Supports 25 Policy Committees

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Communities Across the State Informed CCO 2.0

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The Transformation Center Engages the Health Delivery System to Transform Care

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465 supportive activities 11,000+ participants

  • Multi-partner learning events
  • One-on-one supports
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Aligning Workforce Goals is Addressing Provider Shortage Areas

OREGON HEALTH AUTHORITY Health Policy & Analytics

  • Over 740

participating providers receive incentives

  • Over 1 million

hours of patient care provided

  • Serving at least

1.2 million Oregonians annually

Total Recipients

  • f Incentives

1-10 11-30 31-50 51+

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Data Helps Policymakers, Researchers, Public Understand Trends, Opportunities

OREGON HEALTH AUTHORITY Health Policy & Analytics

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The Hospital Pricing Report Shows Variation in Pricing

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Price of colonoscopy by hospital: $1,200 to $4,100

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Measuring and Paying for Outcomes Improves Care

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11% 19% 22% 24% 2014 2015 2016 2017

Dental sealants for children

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Performance Reports Measure CCO Quality Improvement and Community Outcomes

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Lower is better

Tobacco use prevalence, 2016 and 2017 Health assessments for children in DHS custody, 2016 and 2017

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What Do We Mean by Value-based Payments?

OREGON HEALTH AUTHORITY Health Policy & Analytics

  • Current “fee-for-service” model pays providers based on quantity
  • f services
  • Value-Based Payments (VBP) link provider payments to improved

quality and performance instead of to the volume of services

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Aligned Goals Across CCOs, PEBB, and OEBB Will Increase Value-based Payments

OREGON HEALTH AUTHORITY Health Policy & Analytics

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Policymaking and Technical Assistance Have Increased the Focus on Primary Care

OREGON HEALTH AUTHORITY Health Policy & Analytics

Primary care spending as percent of total medical spending, 2017

$72 $47 $43 $43 $603 $244 $279 $306

Medicare Advantage CCOS Commercial plans PEBB & OEBB

16.5% 13.4% 12.2% 10.6%

CCOs Commercial plans PEBB & OEBB Medicare Advantage

Primary care spending per member per month, 2017

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Pooled Purchasing Results in Better Deals

  • n Prescription Drugs for Consumers

OREGON HEALTH AUTHORITY Health Policy & Analytics

56,080 1,047,528

2007 2010 2012 2014 2016 2019

Northwest Drug Purchasing Consortium enrollment

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OREGON HEALTH AUTHORITY Health Policy & Analytics

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A Patient-Centered System Treats the Whole Person

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Patient Centered Primary Care Homes Improve Care and Reduce Costs

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  • Six core attributes,

each with specific standards and measures for clinics

  • 85% reported

improved care

  • 82% reported

improved population health management

  • $240M in savings

(2012-2014)

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Evidence-Based Policies Improve Value and Promote Better Care

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The Health Evidence Review Commission:

  • Reviews clinical evidence to inform

benefit-related decisions for the Oregon Health Plan and beyond

  • Publishes Prioritized List of Health

Services

  • Shapes practice change to provide

evidence-based and cost-effective care

  • Reports on multi-sector interventions

that have the potential to influence paraclinical services, systems, & policies

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Electronic Health Records Help Improve Quality and Coordination of Care

OREGON HEALTH AUTHORITY Health Policy & Analytics

1,282 3,207 4,050 4,701 4,771 4,831 4,831 912 1,519 2,043 2,561 3,052 3,794 3,818 2,194 4,726 6,093 7,262 7,823 8,625 8,649

2011 2012 2013 2014 2015 2016 2017

Cumulative number of Oregon eligible professionals receiving at least one payment

  • f the $525 million in federal EHR incentives:

Medicaid & Medicare

28% 54% 68% 68% 78%

2011 2013 2014 2015 2016

EHR adoption among CCOs, statewide:

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Technology Improves Care for Patients with Complex Conditions

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HIT Commons is Spreading Electronic Health Tools Statewide

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Combining Data Helps Us Better Address Social Determinants of Health for Children

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Combining Data Helps Us Better Address Social Determinants of Health for Children

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Challenges

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Challenge: Health Care Remains Unaffordable for Many

Since 2000, Oregon employer-sponsored insurance premiums have grown three times faster than personal income

OREGON HEALTH AUTHORITY Health Policy & Analytics Family premiums (MEPS IC, Oregon) Personal income in Oregon, per capita (BEA) Worker contributions to premiums (MEPS IC, Oregon)

0% 50% 100% 150% 200%

2000 2005 2010 2017

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Challenge: National Health Care Costs Expected to Outpace State Growth Target

Limiting the per capita annual growth rate in Oregon to 3.4%, instead of the 4.7% national forecast, will save the State almost $700 million

OREGON HEALTH AUTHORITY Health Policy & Analytics

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Challenges: CCO 2.0

  • CCO 2.0 success depends on additional technical assistance and

expanding focus beyond Medicaid – Value based payments – Social determinants of health and health equity – Behavioral health – Containing costs

  • Renewed focus on cost and cost drivers (including pharmacy) result

in increased policy and data analytics capacity needs

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Challenges: Improving Health Requires Looking Beyond Health Care

  • Greater focus on social determinants of health requires new

expertise

  • Maximizing improved outcomes for children requires bridging

multiple social and health systems

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Challenges: Policy and Data Needs

  • Renewed focus on cost and cost drivers (including pharmacy)

creates increased policy and data analytics capacity needs

  • Federal health IT enhanced funding ends in 2021

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Proposed Budget

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2019-21 Governor’s Budget by Fund Type

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2019-21 Governor’s Budget by Program

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HPA 2019 Budget and Policy Priorities

 Set Medicaid funding on a sustainable path for the next six years (HB 2269)  Transform health care delivery and reduce costs

  • Support implementation of CCO 2.0 (POP 416, HB 2267)
  • Improve CCO financial reporting and solvency (HB 2268)
  • Support PEBB, OEBB to meet 3.4% growth target
  • Pharmacy costs (POP 422)
  • Support development of statewide health care cost benchmark

(SB 889)

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HPA 2019 Budget and Policy Priorities

 Help families give their children a healthier start in life

  • Establish Office of Child Health (POP 404)

 Improve behavioral health

  • Improving behavioral health (POP 411, POP 409)
  • Hospital emergency department discharge data collection (SB 23)

 HPA housekeeping (HB 2265)

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POP 416: Launch and Support CCO 2.0

  • Increase investments in Social Determinants of Health
  • Expand adoption of value-based payments
  • Improve use of data to control costs, improve quality
  • HB 2267 and HB 2268 improve financial oversight of CCOs and

implement policy changes in CCO 2.0

General Fund Total Funds Positions

POP 416 $1.1 M $1.9 M 7

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OREGON HEALTH AUTHORITY Health Policy & Analytics

POP 422: Statewide Pharmacy Implementation Group

  • Expand capacity for identifying and implementing pharmacy cost

containment strategies

  • Leverage the Oregon Prescription Drug Program to lower costs

General Fund Total Funds Positions

POP 404 $0.4 M $0.7 M 2

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OREGON HEALTH AUTHORITY Health Policy & Analytics

POP 404: Office of Child Health

  • Serve as an agency hub for cross sector partnership and strategies
  • Deploy targeted, innovative approaches to address children’s health

complexity and health disparities

  • Measure effectiveness of interventions to improve outcomes

General Fund Total Funds Positions

POP 404 $0.6 M $1.0 M 4

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POP 411 (SB 22 & HB 2035): Improve Behavioral Health Integration

  • Integrate primary/behavioral health through Behavioral Health Home

Program (SB 22)

  • Spread adoption of electronic health records to behavioral health
  • Expand evidence-based guidelines for treatment of mental health

conditions (HB 2035)

General Fund Total Funds Positions

POP 411 $5.4 M $5.7 M 4

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OREGON HEALTH AUTHORITY Health Policy & Analytics

POP 409: Opioid Alternatives for Pain Education

  • Develop continuing education modules on opioid alternatives to paid
  • Spread best practices in prescribing and promote effective

approaches to pain management

  • Enable OHA to increase capacity to analyze data related to patients

with chronic pain and substance use disorders

General Fund Total Funds Positions

POP 409 $0.3 M $0.4 M 1

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Thank You