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Lessons Learned from Health Care Reform

Lessons Learned from Health Care Reform. Presentation to Citizens’ Health Care Working Group September 23, 2005 Jean Thorne, Administrator Oregon Public Employees’ Benefit Board (PEBB). Background. State Medicaid Director 1987-1995 Director, Department of Human Services 2003-2004

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Lessons Learned from Health Care Reform

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  1. Lessons Learned fromHealth Care Reform Presentation to Citizens’ Health Care Working Group September 23, 2005 Jean Thorne, Administrator Oregon Public Employees’ Benefit Board (PEBB)

  2. Background • State Medicaid Director 1987-1995 • Director, Department of Human Services 2003-2004 • Administrator, PEBB 2004-Present

  3. Pre-Oregon Health Plan • 1987 • Coverage for transplants discontinued • Coverage for pregnant women and children expanded • Discussion of trade-offs begins • 1988 • Growing public awareness of need for health care reform

  4. Pursuing Federal Waivers for OHP • Criticism from national advocacy groups • National press focus on health care “rationing” • Importance of a united front • Discussion of trade-offs • National reaction when waiver denied

  5. Implementing the OHP Changes occurring • Benefits based on prioritized list • Managed care delivery system • Expansion of eligibility to FPL Approach • Start-up would not be delayed • Constant communications • We’re all in this together

  6. OHP Start-Up (under a national spotlight) • Cries for coverage • No “big stories” • Change in press focus • Working through the kinks • Involvement of advocates • Being part of positive change

  7. Use of the Prioritized List • Tool to force explicit policy decisions • Allowed policy makers to reduce services in rational manner • Unwillingness of federal government to accept • Impact on ability to sustain program

  8. Purchaser Role in Moving Change • PEBB Vision for 2007 • Systems of care • Outcomes • Evidence-based medicine • Transparency • Need for provider ownership • Collaborative efforts in a competitive market? • Challenges in engaging members

  9. Lessons Learned • We’re all part of the problem – and the solution • No magic bullets – trade-offs are necessary • Need for provider ownership to achieve change • Importance of credible political leadership • Stakeholder groups can help • Media can be a partner

  10. Challenges • Limitations of a competitive model • Need for all providers to focus on greater good • Limitations of a consumer-based approach • Limitations of a purchaser-based approach • Gaining public understanding of a complex issue

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