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Oregon Health Care Reform "Letting Go of the Rope" Timothy L Keenen, MD Orthopedic Spine Surgeon Tualatin, OR Timothy L Keenen, MD Orthopedic Spine Surgeon.

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Presentation on theme: "Oregon Health Care Reform "Letting Go of the Rope" Timothy L Keenen, MD Orthopedic Spine Surgeon Tualatin, OR Timothy L Keenen, MD Orthopedic Spine Surgeon."— Presentation transcript:

1 Oregon Health Care Reform "Letting Go of the Rope" Timothy L Keenen, MD Orthopedic Spine Surgeon Tualatin, OR Timothy L Keenen, MD Orthopedic Spine Surgeon Tualatin, OR AAOS Fall Meeting October 20, 2012 Philadelphia, PA AAOS Fall Meeting October 20, 2012 Philadelphia, PA

2 US Health Care Spending 18 % of GDP 25% by % of Federal Spending 40% by 2037 Accountable Care Organization (ACO) Fee for Service

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4 3,800,000 2,000,000 40% D 30% R 25/5 %

5 2012 3,800, ,000 Medicaid 300,000 public employees / teachers 25% state funding for health care 16 % budget Oregon Health Plan 1993 waiver from Bill Clinton 2,900, ,000 medicaid oregonians

6 John Kitzhaber, MD State Legislator (President of State Senate ) Governor Archimedes Movement 2006 Governor 2011-present

7 US health care assumes that the public sector and private employers will continue to fund the medical inflation rate faster than CPI and that this will continue to be funded without evidence of positive outcomes. Gov. John Kitzhaber

8 Three strategies 1. Decrease provider reimbursement 2. Decrease number of patients covered 3. Decrease patient benefits

9 The new rope we are grabbing onto….. Outside fee for service Global Payment Bundled Payment Pay for Performance Outside hospital and doctor office Flexibility Technology Coordinated Care Organizaion CCO Local Flexibility Cost / Outcome Management

10 2007 Oregon Health Fund Board (OHFB) 2009 Oregon Health Authority (OHA) Oregon Health Policy Board ( OHPB) 2007 Oregon Health Fund Board (OHFB) 2009 Oregon Health Authority (OHA) Oregon Health Policy Board ( OHPB)

11 Oregon SB 99 (June 2011) State Health Insurance Exchange Market place for apples to apples comparisons for insurance Central elements to move from Medicaid into the private market

12 : 3650 HB June 2011 Coordinated Care Organizations (CCO) A service integration, care coordination, focus on wellness, prevention and community based management of chronic conditions medical care. Population health rather than simply the delivery of medical care Risk adjusted global budget that grows at a fixed rate Accountability for performance standards around access, around clinical outcomes, and around metrics for improving population health

13 SB 1580 February 2012 Senate vote (16D 14R) House 53-7 vote (30D 30R) CCO adopted as a plan Established application / certification process Tort Reform deferred to 2013

14 Differences Commonalities Reduce incentive for providers to earn more by treating more Improve coordination / integration of care Focus on use of Information Technology ACO Accountable Care Organization PCMH Patient Centered Medical Home CCO Coordinated Care Organization

15 May 1, 2012 Federal Waiver Payment: $1.9 billion dollars from HHS over 5 years Federal requirement: 2% decrease in the Medicaid per member inflation rate trend by the end of the second year (down to 3.5%) Savings: $ 1.9 billion over 5 years $11 billion over 10 years

16 The grand bargain was they give us the flexibility, they give us $1.9 billion, we reduce the Medicaid cost trend by 2 percent points per member by the end of the second year and improve health outcomes. Thats the grand bargain.

17 Health Evidence Review Commission (HERC) Health Technology Assessment Subcommittee

18 SK: How will the administration measure what counts as higher quality care? How do you safeguard against providers skimping on care? JK: There are metrics were developing with [the Center for Medicare Services] about patient outcomes and population health metrics. So this is clearly unlike an old HMO, which could save costs by skimping on care.

19 Reimbursement Fee for Service Global Payment Bundled Payment Contract ? Strategic Pathway ? RCT based Patient Registry based Treatment Outcome Measure? Pay for performance What can I do?

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