On Wednesday, June 25th, I attended the all day meeting of the Oregon Health Fund Board, held in Milwaukie. During the morning session, the Board heard three reports. In the afternoon session, they received a "Straw Person" Plan from their director, Barney Speight. The two sessions could not have been more different.

In the morning session, the Board first heard a preliminary report about the OHFB community meetings held across the state in May and June. Giving this report were our own Archimedes director, Liz Baxter, and Carol Robinson of Oregon Health Forum.

They stated that 1285 Oregonians participated in a total of 15 community meetings. The data obtained is still being compiled, but you can download the preliminary report. In the preliminary report, the broad categories of themes expressed at the meetings are listed. For example, one is "Health of Population", meaning that a reformed health care system needs to focus on health, not just health care, and include all dimensions of health, including prevention. The final report will be given to the Board by next month's Board meeting.

Next, the Board heard the final recommendations of the Benefits Committee. The Benefits Committee began their work with the prioritized list and modified it to create a new design that promotes the integrated health home, incentivizes the use of preventive care and chronic disease management, and also uses cost share as an tool to incentivize types of care. Unlike the OHP, where cost share is based solely upon income level, under the new Essential Benefit Plan (EBP) cost share is also adjusted according to the role of the service in promoting health. For example, although the plans have a high deductible, basic diagnostics, comfort care, Rx's, and value-based services, are all exempt from the deductible. You too can download the Benefits Committee report (PDF).

To close the morning session, the Board heard the final report from the Finance Committee. The role of the Finance Committee was to answer the difficult question, "How will health care reform be financed?" A majority of the committee recommended that 60 to 100% of the revenue should be raised from a payroll (play or pay) tax. A majority also would like to see an additional revenue source, either from a health services provider tax, or an increase in the state income tax. Accordingly, the final report does not give one single recommendation to the Board, but instead lists a number of options. You too can download the Finance Committee report (PDF).

In the afternoon, Barney Speight, Executive Director of the Oregon Health Fund Board, gave a presentation on the first version of an actual plan for the Board to consider. You can download Mr. Speight's proposal (PDF).

The plan calls for incremental staged steps that are in two categories: coverage expansion and system transformation. Barney Speight calls his approach both pragmatic and realistic. However, it is not only difficult to see the work of the committees in his plan design, it is also difficult to see the original vision of the "Healthy Oregon Act" (SB329) in it as well.

For example, in phase 1 of his plan, system transformation would be addressed by building a "foundation" in five areas: Information and Reporting, Setting Standards, State Purchasing Policy, Public Health Initiatives (tobacco use, obesity, and POLST), and Community Collaboratives. The work of the Delivery Committee to develop the concept of the integrated health home is not apparent, except as a "test model" at the community collaborative level.

This staged incremental approach also contrasts sharply with the goals of the "Healthy Oregon Act". For instance, the third goal listed in the SB 329 legislation is this: "Ensure that all Oregonians have timely access to and participate in a health benefit plan that provides high quality, effective, safe, patient-centered, evidence-based and affordable health care delivered at the lowest cost.

It remains to be seen whether or not the Board will be able to bridge the gap between the original vision of "The Healthy Oregon Act', the work of the committees that came from this vision, and this new incremental approach. Barney Speight will present a second draft of his plan at the next OHFB meeting on July 24th. That meeting will be held in Portland from 9:30 am to 5:00 pm. We will post more details about this meeting in our calendar as they become available.