Transcript Document
Solutions from the Outside Who Asked You? CONTEXT Health Care Reform Reform is not about health care – it is about money and politics. Health Care costs are between 17-18% of GDP They should be around 11% No health care entity will willingly give up revenue or profit. Health outcomes are what will be achieved after money and politics are decided. Health Care Triangle COST ACCESS QUALITY Health Care Reform Demand – Causes Genetics, environment, economic status, education....... Access – How one gets into the system Finance – Who gets paid what Price – Controlling the market Cost – Budget Quality – How good we want the system to be Oregon’s Managed Care History Began in 1985 with PPO risk model for Medicaid Legislature authorized Oregon Health Plan in 1989 Full HMO Model Full integration of all health services except LTC Cost based provider reimbursement Prioritized list of covered services Guaranteed access to providers Implemented in 1995 W/O Mental Health Added Mental Health in 1997, partial success Cost based reimbursement lost in 2003 Key Results of OHP Most comprehensive evidence based benefit list in the US. 14 Fully Capitated Health Plans 2 Insurance companies 12 community based managed care organizations All are full HMO operations 500,000 Clients with guaranteed timely access to care All Clients have a primary care provider Approximate 12% savings per managed care client per year $15 Billion over 16 years 2012 Health Reform Legislature passed Health Transformation act in 2009 Integration of Mental Health and Dentistry Modified Act in 2011 Protected existing MCO’s Set rules for Governance Transparency in Government payments (sort of) CCO’s began operation in August, 2012 What’s a CCO? CCO’s are fully integrated health plans responsible physical, mental, alcohol and drug, and dental care. CCO’s are given a global budget, paid by a monthly premium, that covers full risk for all services. CCO’s are viewed as community based organizations and are required to have community representation regardless of their corporate structure. CCOs are held accountable by reporting performance on quality measures such as prevention, disease identification, ongoing intervention, patient satisfaction and total cost of care. What is changing? Practitioners across the disciplines are talking to each other CCO Insurers are changing their business models Traditional silos: Claims, Customer service, R&A, Care Coordinators, etc. New model: Integrated customer teams – Navigators, referral and social service coordinators for providers, care coordinators and patient mentors. Redistribution of money and services PCP’s paid more and used more. Specialty utilization is down Outpatient and ER services are declining Hospital reimbursement is tied to Medicare methodology and rates are capped Long term cost trends ?? What is being accomplished? Health care is a community effort Integration of health care services is happening Integration of health care, social, housing and food services is being designed and implemented. Community Health discussions now involve Health care providers Social Services Schools Public safety What Does Alaska Do? Medicaid Expansion You pay the Bill either way Reform or not Where do you want your money to go? Health care or other areas? Education, roads, sewers, economic development You get to choose or not choose If you don’t, someone else will