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 December After PEBB dust settles, Regence is biggest winner A $477 million jackpot awaited the victors. But this was no ordinary lottery. The final decision rested with the state’s 48,617 employees and faculty members at Oregon’s public universities. They got to choose which health insurers would take home those dollars. The process couldn’t have been more competitive. Now, after an intensive pursuit to reshape Oregon’s health care delivery system, the Public Employees’ Benefit Board is preparing to sign contracts with four insurers and dole out the dollars based on their enrollment numbers. PEBB is among the state’s largest purchasers of health benefits — after counting dependents, its tally reaches 105,000 Oregonians. Regence BlueCross BlueShield of Oregon walked away with the highest percentage — 75.6 percent representing 37,435 employees and their dependents — after losing 2,326 employees from this year’s count. Legacy Health System hires an outsider Known for his keen ability to increase the operating margin of hospitals, Lee Domanico joins Legacy Health System as its CEO and president in January. After an extensive six-month search by its board of directors, which considered 19 candidates — four of them Legacy employees — Domanico by far “possessed the best match of skills,” and has signed a three-year contract, Dr. Robert Bentley, Legacy’s board chair, told Oregon Health News. He’s signed a three-year contract that includes a renewal clause. “We did a lot of background and research, looking for the most qualified person. He was held in high esteem by both the medical staff leaders and board of his organization,” he said. More hospitals are taking the Leapfrog Little by little, the Leapfrog Group is inching closer to becoming a clearinghouse for hospital quality information. The coalition of more than 170 employers has been around since 1998, but just began moving into Oregon recently thanks to the leadership of Corrie Zenzola of Intel and Barbara Prowe, executive director of the Oregon Coalition of Health Care Purchasers. Thus far 15 Oregon hospitals have signed on. And next year PEBB will require its health plans to include Leapfrog as part of its quality measurements. "As employers are being pressed with costs of health benefits, they're needing to ask employees and unions to be more involved in their health care,” Prowe said. Senator stands up to possible Medicaid cuts Looming in the mistletoe this holiday season are possible reductions to Medicaid benefits. And if all goes according to plan, U.S. Senator Gordon Smith (R—Oregon) will feel like Santa Claus. Six Republican senators, led by Smith, vowed to oppose any budget reconciliation bill that reduced benefits or increased premiums and co-payments for Medicaid beneficiaries. Such a measure has already passed the House. But if the Senate dissents, it could effectively destroy passage of that budget. “It is vitally important the work of debt reduction not be done at the cost to the most vulnerable," Smith said. “The central strand in America’s safety net is Medicaid, and it must not be weakened.” On the record with Anthony Carvalho Unlike Oregon, which has faltered each time it’s sought approval from the Centers for Medicare and Medicaid Services to reduce benefits, Florida’s had smooth sailing. Undoubtedly, the governor’s connections haven’t hurt. Its reform plan gets underway next July without a hitch. But, in future years, if Florida’s legislature doesn’t appropriate enough money, the health plans can, at will, slash medical services. Perhaps just as controversial, Governor Jeb Bush lost his battle to expand the program beyond a few counties when his Republican-controlled legislature met in special session. Anthony Carvalho, president of the Florida Statutory Teaching Hospital Council and the Safety Net Hospital Alliance of Florida, talked about Governor Bush’s reform plan with Oregon Health News Editor Diane Lund-Muzikant. He also appeared at a health care summit in Salem on Dec. 14. OHN: Why did it take Florida’s legislature five days in early December to approve the new Medicaid reform plan? AC: One of the bigger issues was whether the governor could expand his reform plan beyond the pilot areas articulated in the original legislation. The legislature didn’t give him that authority. They did pass a bill allowing the reform to go ahead in Broward, Duval and three rural counties. They made it very clear expansion can only take place with approval from the full legislature. New hospital site comes with baggage McKenzie-Willamette may have locked down a site for its proposed 148-bed medical center, but that doesn't mean it's in the clear. The medical center has secured 42 acres of land on what is presently the back nine of RiverRidge golf course in Eugene. Its location, however, presents several obstacles — the biggest of which is traffic. Hospitals dive into electronic data Look for more hospitals to provide electronic medical record software and online tools for doctors to use in their offices. It’s part of an effort to increase their connection to primary care physicians, which should lower costs and increase health care quality, experts say. “This is something a number of systems have been looking at over the past several years,” said Dr. Jody Pettit, project director of the Oregon Health Care Quality Corporation. But physicians should be wary, said Chris Apgar, a health care consultant who specializes in privacy and security issues. “The physician has to feel comfortable the release of information is appropriate.” Kaiser consumed by construction projects With physician-owned ambulatory surgical centers sprouting up around the state, it’s only a matter of time before hospitals start to feel the impact on their bottom line. In the meantime, Kaiser is taking the matter into its own hands — by building two ambulatory surgical centers. Sunnybrook Medical Office Building, under construction, is adjacent to Sunnyside Medical Center, and one floor will be dedicated to outpatient surgeries, said spokesperson Jim Gersbach. Construction should be completed by 2007. Task force keeps close eye on DHS budget Thus far, the interim hasn’t been much of a vacation for Rep. Dennis Richardson (R—Central Point), who chairs a task force that’s peering into the DHS budget. On Nov. 9, he toured the unused office space DHS is eyeing to relocate 28 to 30 mental health patients from the state hospital who live in a wing deemed unsafe if an earthquake were to occur. Original estimates tag the cost of renovating that space at $750,000 to $900,000, said Richardson. “It looked a lot like a hospital that’s been abandoned in the early 90s,” he said. “It’s going to take a lot of work to make it acceptable for mental health patients.” ODS rejoins OHP The ODS Companies will resume medical coverage for people on the Oregon Health Plan in January after a nearly three-year hiatus, but not to their historic levels. ODS left the health plan in January 2002 after suffering financial losses. Back then it had 30,000 members. This time around, it will limit enrollment to 8,700 people in six rural counties who have very little access to managed care — Baker, Columbia, Jackson, Malheur, Union and Wallowa. Also in this issue...
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