Lessons Learned from Health Care Reform Presentation to Citizens’ Health Care Working Group September 23, 2005 Jean Thorne, Administrator Oregon Public Employees’ Benefit Board (PEBB)
2 Background State Medicaid Director Director, Department of Human Services Administrator, PEBB 2004-Present
3 Pre-Oregon Health Plan 1987 Coverage for transplants discontinued Coverage for pregnant women and children expanded Discussion of trade-offs begins 1988 Growing public awareness of need for health care reform
4 Pursuing Federal Waivers for OHP Criticism from national advocacy groups National press focus on health care “rationing” Importance of a united front Discussion of trade-offs National reaction when waiver denied
5 Implementing the OHP Changes occurring Benefits based on prioritized list Managed care delivery system Expansion of eligibility to FPL Approach Start-up would not be delayed Constant communications We’re all in this together
6 OHP Start-Up (under a national spotlight) Cries for coverage No “big stories” Change in press focus Working through the kinks Involvement of advocates Being part of positive change
7 Use of the Prioritized List Tool to force explicit policy decisions Allowed policy makers to reduce services in rational manner Unwillingness of federal government to accept Impact on ability to sustain program
8 Purchaser Role in Moving Change PEBB Vision for 2007 Systems of care Outcomes Evidence-based medicine Transparency Need for provider ownership Collaborative efforts in a competitive market? Challenges in engaging members
9 Lessons Learned We’re all part of the problem – and the solution No magic bullets – trade-offs are necessary Need for provider ownership to achieve change Importance of credible political leadership Stakeholder groups can help Media can be a partner
10 Challenges Limitations of a competitive model Need for all providers to focus on greater good Limitations of a consumer-based approach Limitations of a purchaser-based approach Gaining public understanding of a complex issue