In its next session, the Oregon legislature has the opportunity to make significant changes to the health system while addressing crises exacerbated by the coronavirus pandemic, as long as all parties work toward solutions, the former Oregon government. John Kitzhaber told The Lund Report.
Kitzhaber knows something about crisis and opportunity. In 1989, as president of the Oregon State Senate and physician, he oversaw the creation of the Oregon Health Plan, the state’s unique take on Medicaid aimed at providing low-income people with access to basic coverage. In 2012, after he returned for a third gubernatorial term, he forged a bipartisan consensus and tapped industry support for new health plan reforms that drew praise across the country.
The following year, Modern Healthcare magazine ranked him nationally as the second most influential person in healthcare.
But in a recent interview, Kitzhaber said there has been a disappointing lack of “transformational” ideas from the healthcare system to address systemic issues. His efforts to win support for a broader vision have yielded mixed results.
“I was a little frustrated,” he said, “and I’m not quite sure what their strategy is.”
The obvious reason, according to Kitzhaber, is that leaders within Oregon’s health systems are too overwhelmed to look beyond the current crises, which he calls “a real missed opportunity.”
He said, “For me, it’s like standing in front of a train and being afraid to jump off the tracks because you might break your ankle.”
Kitzhaber told The Lund Report that health care and political leaders in the state — many of whom are in new positions of power after the last election — need to coalesce around a vision of what Oregon’s health system should look like now and in the future, and start building toward it, with a focus to reduce costs at the system level.
Kitzhaber has remained active in healthcare policy in recent years, sharing his insights with political leaders, giving speeches And he does some consulting work outside the country, he said. He also sits on the board of directors for the national repair group, Family USA.
For him, the current health care staffing crisis and caregivers’ desire to moderate health care cost growth targets in Oregon present an opportunity for lawmakers.
Oregon’s hospitals and health care providers are facing widespread staffing shortages, and bed capacity has been near its limits since the pandemic began. Shortages and labor costs have pushed healthcare inflation above the 3.4% target set by Oregon lawmakers in 2021, exposing them to penalties for caregivers.
Study after study finds that the nation’s dominant fee-for-service model of care fuels a surprising amount of waste, and 30% or more of healthcare spending is unnecessary. Kitzhaber has long pushed for a more efficient, value-based model, and said Oregon State can make progress by capitalizing on the need to address current health care workforce shortages.
In a value-based pricing system, a healthcare provider receives a fixed price per person per year and must provide certain services to a large number of patients. In the current fee-for-service model, each action is charged at a different rate based on negotiated rates.
Kitzhaber said value-based reforms would be a more effective way to lower health care costs than the public option, a progressive policy that Democrats have been hoping to implement at the state and federal levels for years.
“Somehow we need a strategy that actually changes the underlying payment model, which public option doesn’t,” Kitzhaber said, adding that while public option will change how the system is funded, financing will still pay for “an unsustainable and inefficient delivery model.”
Kitzhaber has it He circulated his thoughts among Oregon health care and political leaders, but he said he wanted any billing for solutions to come from within the system itself.
While the cooperative grand settlement as envisioned by Kitchaber has yet to emerge, other pieces of legislation have already been introduced.
The Oregon Nurses Association is behind a bill that would set minimum staffing standards for hospitals to manage burnout and staff retention issues. Meanwhile, legislative leaders have spent most of the past year looking at creating new health insurance The Bridge Program For people with incomes between 138% and 200% of the federal poverty level.
On value-based care, Rep. Maxine Dexter, D-Portland, joined Sen. Dick Anderson, R-Lincoln City, and Rep. Lisa Reynolds, D-Portland, to introduce House Bill 2878which would establish a pilot program in one area to see how it might work.
Changing the platform, Kitzhaber said, should be the priority. As for the “bridge” plan, he worries that removing those who make up less than 200% of the federally subsidized individual health insurance market will destabilize it and increase prices for those who make up 201% of the federal poverty level and above.
The individual market served by the market is where Kitzhaber believes a larger compromise around value-based reforms can take hold.
“I think the idea of attaching some short-term mitigation of cost growth targets to a strategy that really starts to change the payment model in a portion of the commercial market — which I would say would be the individual market — it solves the problem that Bridge is trying to solve, but in a more comprehensive way.”
Additionally, Kitchaber expressed concern about Oregon’s 2012 health plan reforms, which centered around local control of the insurance contractors who serve it on a regional basis, known as co-ordinated care organizations, or CCOs.
Centene, a for-profit multinational, now operates two regional CCOs, and CareOregon, which operates two CCOs and is part of another, recently Announce the proposed merger to become part of a California-based nonprofit, though its executives say CareOregon’s operations will remain in the state.
For Kitzhaber, lawmakers should look to achieve three things:
- Postpone the next round of CCOs and rethink what a CCO system should look like to focus on local control.
- Start moving away from the fee-for-service model of the individual health insurance market and replacing it with a value-based capital one.
- Look for federal funding to trigger a push toward lower cost growth in the commercial health insurance market.
Kitzhaber returned to a topic he raised last October in a keynote address at the Reform State Conference In Portland: The need for Oregon’s leaders to bring key health care players to the negotiating table to piece things together.
Right now, Kitchaber said, healthcare leaders don’t have a forum where they can work together toward a common goal.
Legislators can use their positions to bring together various elements of the health care industry to work on legislation. Gov. Tina Kotek would be the obvious choice, Kitchaber said, because the governor tends to command the most power when holding disparate parties.
Time is of the essence, he said: “The longer we wait to have that conversation, the less likely we are to be able to shape what happens in health care over the next couple of years.”
Reporter Connor Radnovich can be reached at [email protected].