OBJECTIVE
Influence the direction and pace of system transformation in local and statewide markets through coordinated and aligned purchasing policies by the state and other government entities. Encourage voluntary adoption and participation by private purchasers.
STRATEGIES
Strategy: Develop and implement uniform contract standards and policies for the State of Oregon (Oregon Health Plan, PEBB, OEBB).
The state – in partnership with communities – must act as a smart purchaser of health care. As a major purchaser of health care, the state must align and coordinate its purchasing standard and contract requirements to maximize its influence in local health care markets in terms of
performance standards, innovation in care delivery, and cost. The Authority will lead the development of uniform purchasing standards and contract requirements for use by state agencies that buy health care services. The State must be an instigator for and early adopter of the major system transformation strategies outlined in this plan, including:
Common evidence-based guidelines and best practice clinical standards;
Comparative effectiveness research to evaluate the appropriate use of new technologies;
Standard clinical and service quality measures to compare provider performance and patients’ experiences;
The Integrated Health Home, behavioral health integration, and other new models of care delivery that promote wellness, prevention, early intervention, and
comprehensive management of chronic diseases;
Employee wellness programs that align with strategic public health objectives and focus on behavioral risk factors that contribute to chronic disease;25
Health information technology requirements (electronic medical records, electronic prescribing, etc.) that comply with national and state standards;
Decision support programs that inform and empower patients to be involved, along with their provider, in critical, preference-sensitive health care choices; and
The Oregon Prescription Drug Program (OPDP) as a benchmark for purchasing and managing prescription drug benefits.
Strategy: Create a Public Employers Health Cooperative
The Authority will organize and manage a Public Employers Health Cooperative. State agencies, counties, cities, and other local governments along with their associations will be invited to participate. The Cooperative will encourage wide adoption of uniform purchasing standards and contract requirements. The Cooperative will collaborate whenever possible with private
purchasers (labor trusts, self-insured employers, Oregon Coalition of Health Care Purchasers, association plans, etc.) in the development and implementation of uniform standards and policies.
The pace of innovation in local delivery systems rests, in large part, with the goals and requirements expressed by purchasers – public and private – either through their respective insurers or, alternatively, directly to the provider community through collaborative and cooperative actions.
The objective of the Cooperative, its members, and collaborators is to consolidate purchasing power in local markets and transform the purchaser-payer-provider relationships to achieve improved quality and value. Employees of state government, state education institutions, and local governments and their dependents exceed 500,000 lives. Enrollment in the Oregon Health Plan currently stands at close to 420,000 people. With the coverage expansions proposed in this plan, the combined populations of non-federal public employees (and dependents) and the OHP will be about 1,000,000.
The Integrated Health Home concept and other new models of care can be quickly introduced in communities if purchasers collectively bring membership scale (members using IHHs) to providers in support of the business/clinical model. In the case of IHHs and other models of chronic disease management, public employers should provide financial incentives to members to use an IHH or community-based chronic disease program. Incentives could include waived or lower co-pays, lower co-insurances, or services not subject to a deductible.
This strategy does not suggest that public employers who adopt model contract standards must have similar benefit designs or cost sharing. The collective action envisioned is around
performance requirements for providers and health care systems (clinical and service standards
25
This is in line with the Governor’s recently announced Wellness Initiative. For more details, see
and reporting), the use of common evidence-based guidelines for utilization management, and comparative effectiveness guidelines for new technologies. The long-term goal is for every Oregonian to have the Essential Benefit Package of covered health services.
Based on the interests of the participating public employers, the Public Employers Health Cooperative could eventually contract directly with providers for specified services such as cardiac or cancer services. The Cooperative could also contract directly with providers at designated facilities such as Centers of Excellence.
The Oregon Prescription Drug Program (OPDP) is an innovative joint contract for pharmacy benefits that includes both the State of Oregon and the State of Washington. As of July 31, 2008, OPDP has enrolled 83,560 Oregonians in a prescription discount card program and 18,671 persons in group contracts. On October 1, the group number will increase to 104,000 with the inclusion of Oregon Educators Benefit Board members. State policy should require all health plans contracting with the state, county, city, and local governments to provide their pharmacy benefit management (PBM) services through OPDP unless they can demonstrate greater savings through an alternative arrangement.
Strategy: Expand the scope and reach of the Public Employers Health Cooperative The Authority and the Cooperative will seek new partners in this collective and collaborative effort:
¾ The Oregon Health Insurance Exchange
¾ Private purchasers, including large self-insured employers, labor trusts, etc. These strategies are intended to evolve over time as follows:
The State of Oregon Oregon Health Authority Oregon Health Plan, PEBB, OEBB
Public Employers Health Cooperative State of Oregon
Counties, Cities, Local Governments Government Association
Oregon Health Insurance Exchange
Private Purchasers
Strategy: Create opportunities for city and county governments and private entities to use uniform contracting standards.
ACTION STEPS
1. Authorize the Authority to develop and implement uniform contracting standards. The Legislature authorizes the Authority to develop uniform contracting standards for state agencies that purchase health care services. Working with and through the Health Services Commission, the Health Resources Commission, and organizations involved in clinical quality metrics, the Authority initially focuses on the development of: a) a standardized set of quality performance measures; b) evidence-based guidelines and best practice clinical
standards for major chronic diseases, services with unexplained variations in frequency, or cost and “supply sensitive” services; and c) evidence-based guidelines for select, new technologies based on comparative effectiveness research.
2. Convene public employers to implement purchasing strategies to improve the value of health care purchased.
Legislative direction to the Authority includes broad authority to convene representatives of public employers to collaborate with the state in the development and implementation of joint, voluntary purchasing policies, standards, and programs to improve the value of health care services purchased by public employers and effectuate the reforms contained in this Action Plan.
3. Provide opportunities for other public and private purchasers to use uniform contracting standards.
4. Require the use of the Oregon Prescription Drug Program by state agencies, county, city, and local governments.
The Legislature directs state agencies, county, city, and local governments that purchase health care services to implement contracting standards that require the use of the Oregon Prescription Drug Program unless the contractor or prospective contractor can demonstrate greater savings through alternative arrangements.