Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, assures officials he’s behind Oregon’s efforts
February 17, 2011--Oregon’s transformation healthcare plan is falling into place, with draft legislation expected by March 23.
However, Governor John Kitzhaber dismissed speculation about a predetermined “secret plan” at last night’s Transformation Team meeting.
“We’re putting together that secret plan here,” said Dr. Bruce Goldberg, director of the Oregon Health Authority, “and this is a less-than-secret environment.”
That plan must come together before April, Kitzhaber asserted, and cannot be “an endorsement of the status quo. If we don’t do it, this system is going to go off the rails.”
Dr. Donald Berwick, who’s a friend of the governor and heads the Centers for Medicare and Medicaid Services, emphasized the importance of Kitzhaber’s oft-mentioned “triple aim” objectives – better healthcare, better health, lower costs – and praised Oregon for being a “beacon” that could “show our country some solutions.”
Focusing on the dual eligible population, he said, “This population is absorbing a tremendous amount of resources,” said Berwick, “but their condition is impeded because of the system’s fragmentation” of physical, mental and dental healthcare. The solution? Healthcare reform’s current buzzword: integration.
That population, which currently numbers 59,000, represents 14 percent of Oregon’s Medicaid participants, but accounts for 27 percent of its spending.
“It’s really local communities that have the potential for developing real integrated systems of care,” Berwick said. Through this community-based, integrated approach, he added, patients’ health concerns could be addressed and tracked before they became serious enough for hospitalization.
“Hospitals would seek to become empty,” said Berwick. “Prevention has to become lucrative.”
Sen. Alan Bates (D-Ashland) asked Berwick for specific direction. “Do you have specific benchmarks for what a system like this should look like?” he asked, seeking answers about how to best integrate healthcare and long-term care services. For example, he asked, are there any benchmarks for the potential cost per member month for such services, hospital reimbursement rates, or other revenue figures that could help Oregon go down this path.
“The variation around the country is phenomenal,” Berwick responded, which makes it difficult to establish such benchmarks. However, he added, “there’s a lot of debate over those variations, and whether they’re real or not.”
Berwick’s office is studying the cost and outcome differences across different geographic regions of the country to “give us a basis for rulemaking in 2012,” he said, and “help us understand what’s real and illusory.”
First and foremost, though, he said, Oregon’s leaders should pitch ideas to CMS’s Innovation Center, which is stocked with funds to support state pilot projects.
“What are your goals, and how can we help you get where you want to be?” Berwick asked the group. “We’re very open to ideas.”
The 45-person Transformation Team has five more weeks to set benchmarks, meet budget targets, and refining a bid process as well as work on legislation and federal waivers.
Currently, close to 500,000 people receive healthcare service through the Oregon Health Plan, and that figure represents 15 percent of all Oregonians and almost 38 percent of all children. By 2019, Oregon’s Medicaid enrollment is expected to increase b y almost 60 percent, according to the Oregon Health Authority.