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 December Oregon employer coalition explores direct contracting Saddled with rising insurance costs, Oregon's employers may reshuffle their purchasing power. They're seriously considering a new contracting method that cuts their costs and gives them quality outcome data -- while placing the consumer in the driver's seat. A feasibility study underway by Patient Choice Healthcare in Minnesota could open the floodgates for direct contracting. The Oregon Coalition of Health Care Purchasers, which represents 400,000 lives, will receive the study results in February and could sign contracts by summer. " We're on a fast timetable, " said Ann Robinow, president and CEO of Patient Choice. " Oregon is a really good market because providers are pretty organized. They understand why this makes sense. There's a lot of interest in trying something that really rewards them for investing in quality improvement and allows them to have a more accountable relationship to patients. " Primary care physicians are central to this direct contracting approach. They control the flow of dollars to specialists and hospitals as well as the drug budget. Every three months, employers receive claims reports and clinical outcome data. Workers' compensation lawsuit could upend the system A bill to significantly change Oregon's workers' compensation system will be among the first proposals considered by the 2001 legislature. It incorporates changes recommended by a labor-management committee assembled by Gov. John Kitzhaber earlier this year. Because the changes represent a consensus from both sides of the volatile workers' compensation system, the bill is likely to have Kitzhaber's support and stands a good chance of being adopted despite several controversial recommendations. " It is a compromise that seeks to balance certainty of fair benefits for workers injured on the job with certainty of fair and manageable costs for employers, " committee members told Kitzhaber when they presented their recommendations. CareOregon holds off on mental health As CareOregon prepares to take over the Oregon Health Plan members from Regence HMO Oregon and Providence Health Plan in Portland, everyone assumes they also have mental health services in mind. But CEO Mary Lou Hennrich remains cautious. " My board has allowed my staff and myself to look at Multnomah County's mental health system, but there's been no commitment to be involved. We're just looking. " By April, 25,000 Regence members will belong to CareOregon; while Providence's 20,000 members complete their transition June 30. Insurers report healthy earnings Oregon's largest insurers are enjoying healthy earnings despite their complaints about rising medical and pharmaceutical costs. HealthNet, Kaiser, PacifiCare and Regence HMO Oregon landed in the black during the third quarter, while their membership stabilized. Providence was the lone exception and is planning a vigorous case management approach and oversight of expensive tests to rein in costs. Not surprisingly, all the HMOs will follow the national trend and increase premiums in the double-digits again next year. Their PPO partners will likely follow suit. True to form, Kaiser spent the least on administrative costs, while HealthNet landed at the bottom for medical-hospital expenditures. Oregon Health Forum obtained data from the Insurance Division for this report and verified all the numbers with the health plans. High technology reaches Unity James Gaynor wants mental health consumers wired to the Internet so they can talk to their cohorts across the country " in real time " and determine which treatments work best. This high-tech experiment is typical of the businessman's savvy Gaynor brings to his new job as CEO and president of Unity, Inc., Oregon's largest mental health care provider, which has a $14 million budget and 300 employees. Gaynor, 44, sprinkles his conversation with phrases from the high-tech world, a results-oriented cosmos he'd like to introduce to mental health. " Despite the best intentions of many talented people, the system continues to chug along toward entropy, " Gaynor said of the behavioral health field in Portland. His litmus test? Whether a service increases value for consumers while reducing the cost of care. He plans to " ramp up the infrastructure " at Unity. That means standardizing policies and procedures, building and wiring an e-commerce workplace and implementing information systems and technologies that will allow Unity to measure results. Debate ensues over mental health court Two years ago Peter Klarquist sat alone in a Multnomah County jail cell. Charged with a minor crime, the young man sank into psychotic despair and gouged out his eyes. His case triggered outcries for a mental health court. Such courts, successful in 10 states, divert people with mental illness into treatment rather than jail. But critics charge that people with mental disabilities shouldn't be placed in the criminal justice system. Instead, they're demanding more mental health services without the threat of jail hanging over clients' heads. About 13 percent of prisoners in the Multnomah County Jail have been diagnosed with a mental illness. That represents 200-300 prisoners on any given day. In 1999, 3,484 inmates with " psychiatric alerts " passed through the jail system. The mental health court would start as a pilot project involving 20 offenders who had committed nonviolent felonies and misdemeanors. Genetic privacy scores a victory
The property clause is out, but other protections are in place to balance genetic research concerns with personal privacy rights. Now the proposal from the Genetic Research Advisory Committee (GRAC) heads to the legislature.
The property clause raised the most controversy, said Ted Falk, legal and regulatory advisor for Blue Paws, Insurance For Your Pet, who helped draft Oregon's genetic privacy law that's been on the books since 1995. " Our goal has always been to protect citizens, and that was the original intention of the [property] clause, " he said. " We have said from the beginning that if other protections could be placed in the law then we would give up the property clause. "
The property clause allows Oregonians to claim their DNA as personal property, and ultimately receive a stake in research breakthroughs that used their genetic tissue. Some researchers and pharmaceutical manufacturers were concerned the property clause hampered research efforts. " I think we're all happy with the other protections in this proposal; it's a good balance," Falk said.
Coalition takes on Board of Dentistry Calling it a " professional embarrassment to the state," the Oregon Dental Health Alliance wants to change licensing requirements for dentists and dental hygienists, allowing practitioners from outside Oregon to practice without having to take a board exam. Currently, practical experience from other states doesn't count at all, said coalition member Dr. Steven Duffin, president of Capitol Dental Care.
" We have one of the most restrictive licensing requirements in the country. We're trailing behind most western states in this issue," he said. " Even Dr. Whitney Payne, the state dental director for the Oregon Health Division, a man with a brilliant and distinguished career, is unable to get licensed in Oregon without taking these tests. It's a disgrace."
Long criticizes state's trauma unit The state's trauma unit has been in trouble for some time, according to Dr. Bill Long, chairman of the state Trauma Advisory Board (STAB) and medical director of trauma services at Legacy Emanuel Hospital. In a letter to Gary Weeks, director of the Department of Human Services, Long called the situation " critical " and encouraged officials to resolve problems before " the system begins to unravel."
Long told Weeks there is " no consistency or integrity " used to designate trauma centers.
EMS employees sue Health Division A lawsuit filed against the Oregon Health Division accuses two employees of retaliatory conduct, assaultive behavior and sexual harassment. Lisa Irwin, Wilhelmina Maassberg and Shannon Burnett, who worked in emergency medical services, left their positions under duress, and are each seeking $520,000 from Raymond Jester, who ran the EMS unit, and his supervisor, Tom Johnson. State officials had no comment.
Oregon Health Plan stands at crossroads When it comes to the Oregon Health Plan, one fact remains clear. If the plan isn't reorganized in a substantial way, the state could lose this innovative, trail-blazing formula for achieving universal health care.
With that reality in mind, Gov. John Kitzhaber met with the Health Services Commission, the body charged with developing and maintaining the list of prioritized medical services that is the heart of the health plan. He asked them to come up with a legislative remedy to stabilize and expand the plan. Because of the tight time line, the commission will meet at least four times over the next two months to " figure out exactly what we need to do," said commission staff member Darren Coffman.
" The general sense is we would look at redistributing benefits from some of the current populations to those who are currently uninsured," Coffman said. " The specifics have to be worked out."
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