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 February Life after death for the Oregon Health Plan? Don’t shovel dirt on the Oregon Health Plan just yet. Despite the defeat of Measure 30 and some officials talking loudly about its imminent demise, there are indications the plan may survive. The first positive sign — none of the Medicaid managed care plans have announced they’ll abandon it. In fact, some of the biggest players have vowed to continue providing services to their Standard members even if the state can’t reimburse them. Comprehensive Neuroscience relationships questioned A New York Times article claiming pharmaceutical companies have an undue influence on state officials couldn’t have come at a worse time. The Feb. 1 story alluded to a payment by Comprehensive Neuroscience to Pennsylvania officials for an educational seminar. The money actually came from Janssen Pharmaceuticals. In the article, CNS was described as a marketing company based in White Plains, N.Y. Oregon is preparing to sign a 26-month contract with CNS to do a retrospective review of mental health medications prescribed to Oregon Health Plan patients. Physicians will be encouraged to modify their prescribing patterns by relying on an evidence-based approach. Eli Lilly & Company is funding the project. Until the contract is signed, the amount of money changing hands is unknown. Liability task force underway Not a hint of contentiousness was apparent when the tort reform crisis took center stage at a newly created liability task force. One after the other physicians, their liability insurer and trial lawyers all spoke the same language as if they were one big happy family. There’s a need for data, they all chimed in — reputable unbiased objective data. We’ve heard enough about large jury verdicts and puffed up interest rates, they said. Created by the 2003 legislature as part of House Bill 3630, the task force’s mission is straightforward — hire an actuarial firm to find the root causes of Oregon’s malpractice crisis. It won’t face that challenge alone. Actuaries from SAIF Corporation will select the consultant. Hospitals slighted The federal government must not think hospitals are an important resource for responding to terrorist attacks. The Office for Domestic Preparedness, the agency within the Department of Homeland Security responsible for preparing the country for acts of terrorism, is giving $32.7 million to Oregon this year. Previously, hospitals could apply, but not this year. “The hospitals cannot get funds,” said Bobbie O’Connell, trauma program manager at Good Samaritan Medical Center in Corvallis, at the State Trauma Advisory Board on Jan. 30. Instead, local governments and emergency medical service agencies will receive the money. California dreaming Oregon isn’t the only state punting tough political questions to voters. Californians will decide on Nov. 2 whether employer-mandated health care becomes a reality. If the mandate passes, all companies with more than 50 employees must provide health insurance. Those with over 200 employees will have to cover employees as well as dependents. Governor Gray Davis signed the mandate into law last October. Not long thereafter, a determined coalition including the California Chamber of Commerce and retail, restaurant, taxpayer and business property associations rallied to get enough signatures to refer it to the ballot. Ater talks health care Oregon’s mental health system is a house divided. To fix the notoriously fragmented system, the governor called on some of the brightest minds to co-chair a mental health task force to find solutions. Picking attorney Jonathan Ater was a no-brainer. Three decades worth of experience bailing troubled health care organizations like CareOregon out of sticky legal situations with Legacy Health System has earned him a reputation as the “deal guy.” He spoke to Oregon Health Forum Associate Editor Rory Carroll about serving on the mental health task force and the newly created Health Policy Commission that replaced the Oregon Health Council. OHF: What’s a hotshot attorney like you doing on all of these task forces and commissions? JA: Well, I’m not sure I am a hotshot attorney, but there’s a long tradition in this firm (Ater Wynne LLC) of being involved in community affairs and giving back. These two appointments come out of a lot of work I’ve been doing in the health care world for a long time. If you’ve had the good fortune that I’ve had, where you’ve been well educated and successful, you feel like you ought to give back. This is a way to give back that interests me. OHP contractors vie for Medicare pie With Medicaid populations possibly drying up, health plans are looking to Medicare for greener pastures. To varying degrees, all of Oregon’s Medicaid managed care plans have expressed interest in becoming Medicare certified, and news that Medicare reimbursement rates are on the rise has elevated their interest. Several plans are vying to get certified to provide Medicare benefits to their dual eligibles –– people who qualify for both Medicaid and Medicare. For the common good Another champion is catapulting to the forefront to rescue Oregon’s health care system. Unlike others, however, it doesn’t come with a ready-made solution. Instead, the Metropolitan Alliance for the Common Good is turning to the people. It’s a process similar to Oregon Health Decisions, which led to the creation of the Oregon Health Plan. This time around, five community meetings are envisioned. Using alternative scenarios, people would share their opinions with professional facilitators about rising health costs, quality health care, the uninsured and the role of public and private funding. But that’s only the beginning. The results from these discussions would be disseinated throughout Oregon, informing the public about the intractable costs and conflicts in the system. Assessments steady After the defeat of Measure 30, even the slightest good news for insurers is worthy of a celebration. Expect champagne and caviar when the state’s high-risk pool sends out its latest round of bills. Also known as OMIP, the pool provides insurance for those unable to acquire coverage because of pre-existing and expensive medical conditions. The state picks up 60 percent of the tab, and commercial insurers pay the remainder based on their enrollment. From February 2000 until July 2002, the total bill for insurers (known as the assessment) skyrocketed from $4 million to over $15 million. Last July, it dropped considerably to $10.1 million. The most recent assessment, released in January, stayed reasonably steady at $10.8 million. Six months ago, officials estimated it would be $15 million. Also in this issue...
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