HCAO News

State Punts Medicaid Enrollment to Federal Website with Cover Oregon

State official Tina Edlund told legislators Monday that the state has given up trying to conduct most enrollments for the Oregon Health Plan itself. Like the private insurance consumers, low-income Oregonians will be directed to healthcare.gov to get coverage. Cover Oregon Director Aaron Patnode also explained that a recent error means consumers with certain subsidized insurance plans will owe about $20 more than they were first told.

by Christopher David Gray for The Lund Report, 9-16-14

The state is backing away from any involvement with new Obamacare health enrollments come Nov. 15, with former health authority director Tina Edlund telling legislators Monday that the federal online portal -- healthcare.gov -- will be in charge of new Medicaid enrollments as well as enrollments for subsidized insurance that had been the responsibility of Cover Oregon.

The state will host a website -- oregonhealthcare.gov -- that automatically redirects consumers who either want a subsidized individual health insurance plan or the Oregon Health Plan, to healthcare.gov, as the state gives up conducting its own enrollment for either population.

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A Perilous Gap in Health Insurance Literacy


Caption: This Nov. 29, 2013, file photo shows a part of the HealthCare.gov website. (AP Photo/Jon Elswick, File) Associated Press

Caption: This Nov. 29, 2013, file photo shows a part of the HealthCare.gov website. (AP Photo/Jon Elswick, File) Associated Press

The Wall Street Journal: Washington Wire
Sep 4, 2014 Think Tank

It’s not a news flash that health insurance can be complex and confusing. But the health insurance maze can be a problem, especially if you have never had health insurance before or have not had it for a long time. That’s the case for about half of the uninsured and for many people enrolling in the new insurance marketplaces set up under the Affordable Care Act.
Consider:

  • 37% of enrollees don’t know the amount of their deductible. The deductibles in the plans sold on the exchanges are large; on average $2,300 for single coverage in the most popular plan, a Silver plan.  For many people their deductible will be as important to their family budgets and their ability to get health care as the premium they pay, especially if they get a premium subsidy as most do in the exchanges. If people don’t understand their deductibles and copays they may pick a plan based solely on the premium and be in for a nasty surprise when they begin to use care and their deductible hits. It can also be important to know if services such as some physician visits and tests or generic drugs are exempt from the deductible.
  • Speaking of the subsidies, 46% of enrollees in the new insurance marketplaces say they’re getting a subsidy, when official numbers indicate about 85% actually get them.  And even among those who know they’re receiving a subsidy, 47% don’t know the amount of the subsidy. A political implication is that many people getting help from the ACA don’t know it.

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Oregon health insurers cut $24M in waste, OSPIRG finds

Sep 12, 2014 - Elizabeth Hayes, Staff Reporter- Portland Business Journal

This year’s more in-depth review process for health insurance rate resulted in lower rates on average for next year.

It also produced another benefit: cuts amounting to $24 million in waste and unjustified costs for consumers and small businesses, according to an analysis by Oregon State Public Interest Research Group.

Oregon’s rate review process has cut more than $179 million since 2010, OSPIRG found.

Oregon initiated a new effort to examine the drivers of health care costs this year, as part of rate review. The single biggest factor contributing to the savings were from a reduction in uncompensated care, an upshot of more people accessing public and private insurance, said Jesse O’Brien, OSPIRG’s health care advocate.

Almost all plans saw their projections related to uncompensated care cut by about two percentage points. The Insurance Division also instructed insurers to reduce their estimated growth in medical costs and to rein in their projections for the impact of pent-up demand from people who were previously uninsured.

O’Brien said the $24 million represents money that would have otherwise gone into the system and wouldn’t have been needed. More work needs to be done, however. Studies show that a third or more of all health care spending doesn’t go toward improving health.

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Oregon's test: Cut Medicaid costs while improving health care for poor

Sept. 6, 2014

By Lillian Thomas, Pittsburgh Post-Gazette

Portland, Ore. — Better — and cheaper — health care for the poor could lie in the answer to this question:

Can an air conditioner be considered medicine?

Janet Meyer, CEO of Health Share Oregon, says it can.

"There is the case of a guy with a heart problem," said Meyer, describing a patient who keeps going to the emergency department, where doctors stabilize him and send him home, only to return days later.

"Come to find out, he's in a walk-up with no AC — he has trouble managing his fluids," Meyer said. "We say, 'Maybe what he needs is an air conditioner.' Instead of going back and back to the ER, we buy him an air conditioner and help him manage his fluids."

The end result: Less money spent and the patient's health improved.

Health Share is part of an aggressive effort by Oregon to lower costs and improve medical care in its Medicaid system, a high-stakes undertaking that uses an unorthodox approach and is funded by a $1.9 billion waiver from the federal government that gives the state more flexibility.

The relentless economics of the U.S. health care system have sapped resources in poor areas for decades as hospitals and doctors follow the money in the form of well-insured patients. Doctors and medical care facilities serving large numbers of poor patients have trouble staying afloat because uninsured patients and those on Medicaid are expensive.

While most systems tried to skirt financial losses by avoiding those patients, a handful — from hospitals in Camden, N.J., to Philadelphia to those involved in the Oregon effort — have decided to focus on the poor, making them the centerpiece of efforts to spend less and give better care.

Oregon's effort is centered on the high utilizers — patients who show up frequently for emergency care and readmissions after hospitalization — among the approximately 971,000 people enrolled in its Medicaid program.

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8 facts that explain what’s wrong with American health care

Updated by Sarah Kliff on September 2, 2014 for Vox

1) Americans pay way, way, way more for health care than anyone else

Health care in the United States is expensive. Insanely, outlandishly expensive.

We spend $2.8 trillion on healthcare annually. That works out to about one-sixth of the total economy and more than $8,500 per person — and way more than any other country.

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Basic Health Could Improve Dental Coverage in Oregon

Fact Sheet. Center for Public Policy
September 5, 2014
Click here to download a PDF of this document.

Should Oregon enact a Basic Health Program, more than 87,000 low-income adults could gain access to dental insurance coverage they currently lack.[1] Oregonians without such insurance struggle to obtain necessary dental care and endure costly health problems.[2] Without a Basic Health Program, many low-income adults in Oregon who don’t have health insurance through work will continue to struggle to afford mandated health insurance, let alone dental coverage, which adds to the cost.

Presently, for low-income adults whose income is too high for the Oregon Health Plan, Oregon’s health insurance marketplace offers the best deal on insurance. In the marketplace, low-income adults — those earning between 138 and 200 percent of the federal poverty line — qualify for generous federal premium subsidies. But even with those subsidies, the cost of the insurance will remain out of reach for many of these adults.[3]

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Medicaid Home Births Coming in December, but Not for CCOs

The state plans to adopt an uneasy compromise that will carve out the pregnancy benefit package for women that will be delivered outside of the coordinated care organization program. Finding a permanent fix for such care by CCOs may take further legislation and will likely be an issue in the 2015 session.

By Christopher David Gray for The Lund Report, 9-4-14

Oregon women who receive care through the Oregon Health Plan should get the chance to receive the services of a midwife for normal childbirths starting this winter, but their care will take place outside the coordinated care organizations for the foreseeable future.

Starting Dec. 1, the rules should be in place for women to receive an “open card” for their pregnancy benefit package if they want the services of a midwife. This option will not be carved out of any care they already receive from CCOs, which haven’t found a way to offer the service.

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Insurers shoving “advanced illness counselors” on us

Operator? Business, Insurer Take On End-of-Life Issues By Phone
By Elana Gordon, WHYY
Kaiser Health News, August 27, 2014
Forward by Don McCanne, see comments below.

Kate Schleicher, 27,  is a licensed clinical social worker, who knows almost as little about you as you do about her. Except she knows your phone number, your insurance provider and that you are pretty sick.

Schleicher is one of 50 social workers at a company called Vital Decisions. After sending a letter (people rarely respond) counselors essentially cold-call to offer what they describe as “nondirected” end-of-life counseling.

The hope of this program, she says, is to build a relationship over the phone, so (the patient) might be comfortable discussing his situation and his goals. Then he’ll be empowered to communicate those things with others, including his family and his doctors. He could also choose to allow the counselor to talk to his doctors or family directly. It’s paid for by insurers and federal privacy rules permit this for business purposes.

And when these conversations do happen, there’s can be another byproduct: reduced costs. Res

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Oracle whistleblower figures prominently in state's lawsuit over 'shoddy' Cover Oregon work

 by Elizabeth Hayes Staff Reporter- Portland Business Journal
For Health Care Inc Aug 25, 2014,

The state revealed a secret weapon in its lawsuit against Oracle Cor p.: an unnamed former Oracle employee with first-hand knowledge of what went down at Cover Oregon.

Actually, it’s not clear if it’s one whistleblower or several, but either way, they have a few pointed things to say about Oracle’s work on the troubled website. For its part, Oracle has said the state’s account was “fictional” and that the truth would prevail both in this lawsuit and the one it filed in federal court two weeks ago.

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Oregon health reforms threatened by new federal directive, officials say

A new federal directive has thrown a wrench into Oregon Gov. John Kitzhaber's reforms to the Oregon Health Plan. (The Oregonian/Bruce Ely)

A new federal directive has thrown a wrench into Oregon Gov. John Kitzhaber's reforms to the Oregon Health Plan. (The Oregonian/Bruce Ely)

by Nick Budnick for Oregon Live
on August 21, 2014, updated August 22, 2014

Federal officials have thrown a wrench into the state's high-stakes reforms to the Oregon Health Plan, threatening a program that serves one in four Oregonians.

A new directive could eventually even force the state to return hundreds of millions of dollars received from the federal government – money that's already largely spent.

The federal agency that holds the purse strings for care of nearly 1 million low-income Oregon Health Plan members recently harshly criticized the state's system for distributing money to regional coordinated care organizations under the reforms.

The Aug. 7 letter from the Centers for Medicare and Medicaid Services says the state is employing "high-risk practices" as well as projections that "differ greatly" from those used by the CCOs themselves.

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