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Making the political case for an all-payer, all-claims database: An Oregon perspective

Making the political case for an all-payer, all-claims database: An Oregon perspective. Sean Kolmer, MPH Acting Deputy Administrator Office for Oregon Health Policy & Research Oregon Health Authority. What is the Office for Oregon Health Policy & Research (OHPR)?.

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Making the political case for an all-payer, all-claims database: An Oregon perspective

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  1. Making the political case for an all-payer, all-claims database: An Oregon perspective Sean Kolmer, MPH Acting Deputy Administrator Office for Oregon Health Policy & Research Oregon Health Authority

  2. What is the Office for Oregon Health Policy & Research (OHPR)? • Administrator appointed by Governor and Senate confirmed • Within the Oregon Health Authority • Staff to many Governor appointed bodies • Oregon Health Policy Board • Health Services Commission • Responsible for the development and analysis of health policy in Oregon • Provides analysis, technical, and policy support to the Governor, the Legislature and the Oregon Health Policy Board

  3. Legislative Action in 2009: Companion Bills for Health Reform • HB 2116 • Affordable coverage for all children (Goal=95% children insured) • Expand Oregon Health Plan (Medicaid) Standard program (low-income adults) by 35,000 • HB 2009 • Creates the Oregon Health Authority, overseen by the Oregon Health Policy Board • Sets system reform in motion through key cost containment and quality measures • Establishes an all-payer, all-claims reporting program

  4. The framework for the Oregon system outlined in HB 2009 • Who • Commercial health insurers, third party administrators, managed care organizations, pharmacy benefit managers, Medicaid fee-for-service • Intent to acquire Medicare claims • What • Medical, dental, pharmacy claims • Eligibility files

  5. Key lessons from Oregon’s experience

  6. Lesson #1: Be Committed • Initial efforts in Oregon began in 2005 Legislative session • Since 2005, two significant successes using claims data • OHPR and Oregon Insurance Division collaboration • Oregon Healthcare Quality Corporation (Charted Value Exchange) • Oregon Health Fund Board (2007-2008) • Governor appointed to develop comprehensive health care reform plan • 1 board, 6 committees, over 110 public meetings, 20 town halls, over 1,500 written comments • 2009 Legislative session

  7. Lesson #2: Leverage smaller projects • Failed legislation in 2005 led to Governor directed effort • Governor directed collaboration between OHPR the Oregon Insurance Division (OID) • OID authority to acquire claims already existed • Goal was to increase transparency of costs for common procedures and conditions in hospitals as a tool for consumers, providers and policy makers • Utilize OID authority with OHPR expertise • OHPR has published 4 years (2005-08) of data • Paired with Oregon Inpatient Quality Indicators (AHRQ)

  8. Lesson #3: It’s not about the data but what can be done with it • Foundational element to future health reform efforts • Accountability of public dollars • State is major purchaser of health care • Over 1 in 4 Oregon lives • Over 1 in 3 under 65 Oregon lives • Resource for local communities action • Payment reform development • However, don’t be afraid to show the data you DON’T have

  9. Health care spending in Oregon was estimated at $20 billion

  10. Oregon health care spending may be as high as $25 billion • U.S. spending in 2007 • $2.2 trillion • $7,421 per capita • If previous relationship of Oregon to U.S. spending applies to 2007 • $25 billion • $6,824 per capita Sources: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census. Estimates for Oregon calculated by the Office for Oregon Health Policy & Research.

  11. Lesson #4: Findand support influential champions • Targeted value propositions • One message does not fit all • Governor and Executive branch • Legislative leaders (from both sides of the aisle) • Consumer advocates • Business • Industry • At the end of the day, those at the table have to defend the program

  12. Lesson #5: Utilize the wealth of experience • Expertise and willingness of others was invaluable • NAHDO meetings and webinars laid the foundation for our efforts • NAHDO testimony during 2009 Legislative session • Al Prysunka (Maine Health Data Organization) • Oregon Healthcare Quality Corporation • Many others…..

  13. What are Oregon’s next steps? • Currently in the administrative rules process • Engage vendor Fall/Winter 2009-2010 • Program implementation in Spring-Summer 2010 • Once operational, begin to utilize the system for payment reform efforts and health reform evaluation of cost, quality and access

  14. Contact Information Sean Kolmer, MPHActing Deputy AdministratorOffice for Oregon Health Policy & Research503-373-1824Sean.Kolmer@state.or.ushttp://ohpr.oregon.gov

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