HOUSE COMMITTEE ON AUDIT & HUMAN SERVICES BUDGET REFORM COMMITTEE

 

 

February 13, 2003   Hearing Room 50

3:00PM Tapes  26 - 27

 

MEMBERS PRESENT:            Rep. Ben Westlund, Chair

Rep. Steve March, Vice-Chair

Rep. Jeff Kruse

Rep. Jeff Merkley

Rep. Alan Bates

 

MEMBER EXCUSED:             Rep. Randy Miller

                                                Rep. Susan Morgan, Vice Chair

 

 

GUEST MEMBERS:               Rep. Laurie Monnes Anderson

 

STAFF PRESENT:                  Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

 

ISSUES HEARD:                     Informational Meeting

                                              Overview of the Managed Care Organizations that serve the OHP”

                                                Jeff Heatherington, FamilyCare, Inc.

Ruby Haughton, CareOregon, Inc.

Dean Andretta, Mid-Valley IPA

 

 

These minutes are in compliance with Senate and House Rules.  Only text enclosed in quotation marks reports a speaker’s exact words.  For complete contents, please refer to the tapes.

 

TAPE/#

Speaker

Comments

Tape 26, A

002

Chair Westlund

Calls meeting to order 3:15pm, introduces the invited testimony by Jeff Heatherington, FamilyCare, Inc., Ruby Haughton, CareOregon, Inc. and Dean Andretta, Mid-Valley IPA and opens the informational meeting.

015

Heatherington

Introduces himself and begins his presentation. (EXHIBIT A)

INFORMATIONAL MEETING

075

Berkobien

Asks if there is any difference in fully capitated health plans.

080

Heatherington

Responds about capitated health plans.

108

Rep. Bates

Asks why some of the plans have left and why have some stayed on board.

110

Heatherington

Responds to those who have stayed and those who have left.

138

Berkobien

Asks if there is a 30 day rule for pulling out of the OHP standard or do you have an answer of who may terminate.

140

Heatherington

Answers the questions about the 30 day rule.

159

Kruse

Asks for a history on why SureCare failed.

165

Heatherington

Answers to the best of his ability.

175

Kruse

Makes comments about his knowledge about SureCare.

179

Heatherington

Gives more elaboration.

191

Kruse

Makes additional comments about his knowledge on the subject.

195

Heatherington

Comments.

202

Rep. Bates

Asks what is the difference in cost for different geographical areas providing health care in certain areas.

206

Heatherington

Answers questions about the differences in costs.  Continues presentation.

299

Berkobien

Asks if Jeff evaluates his services and how, and what are the different evaluation levels around the state.

301

Heatherington

Gives explanation about his evaluation process and the processes around the state.

320

Rep. Bates

Asks if he is having trouble holding onto their providers.

330

Heatherington

Responds about holding onto their providers.

344

Rep. Bates

Asks for clarification on capitation and how they managed to do this in Managed Care Plans.

355

Heatherington

Answers about capitation.

372

Chair Westlund

Asks if there are some plans where the physicians are not capitated.

380

Heatherington

Responds yes.

385

Kruse

Asks what is the difference in what you do and a disease management plan.

400

Heatherington

Would like to defer that to a doctor or a nurse, comments to the best of his knowledge.  Continues his presentation on Managed Care Plans.

TAPE 27, A

030

Haughton

Introduces herself and her organization and begins presentation. (EXHIBIT B)

067

Rep. Bates

Asks for definition of a safety net clinic.

068

Haughton

Give definition of safety net clinics.

087

Chair Westlund

Asks for the difference for federally qualified and the non federally qualified.

089

Haughton

Answers questions and elaborates on how the system works.

092

Rep. Bates

Asks if we have to dis-enroll people from OHP, how robust are the safety net clinics.

108

Haughton

Responds that the safety net clinics are at capacity and busting at the seams.

117

Berkobien

Asks the status of  Bush administration initiative for funding of the safety net clinics.

120

Rep. Bates

Asks if the uninsured patients get hospital or specialist care.

127

Haughton

Responds about the uninsured.

134

Rep. Merkley

Asks if the safety net clinics are the same as CareOregon Inc.

139

Haughton

Responds that they contract with the safety net clinics and that they are a part of their panel.

149

Rep Merkley

Asks for history on safety net clinics.

151

Haughton

Give a more clear definition of safety net clinics.

165

Rep Merkley

Asks if they are non-profit programs.

167

Haughton

Responds about the non-profit status and that some are part of a county system.

169

Rep. Merkley

Asks and makes comments that we are not talking about emergency rooms.

171

Haughton

Responds that they are not talking about emergency rooms.

175

Chair Westlund

Comments that he thinks one of their primary functions is to keep people out of the emergency rooms.  Asks how many members they have contractual relationships with.

182

Haughton

Responds about their members.

184

Chair Westlund

Asks if anyone can walk in without insurance and be served.

185

Haughton

Responds that yes, they will see him but will ask questions about his income and may have to pay the clinic a fee.

187

Chair Westlund

Asks if an OHP patient walks in, they will get services and then the clinic will be reimbursed for their fees.

200

Haughton

Responds yes.

206

Rep. Bates

Makes comments about the safety net clinics.

210

Berkobien

Asks if when you contract with these clients do they get a reimbursement and is that build into the contract with them.

219

Haughton

Responds about contracting with clients.

221

Kruse

Asks for clarification about only OHP clients going to safety net clinics.

225

Haughton

Answers about OHP only clients.

227

Kruse

Comments that he understands it is based on the ability to pay, but from the perspective of CareOregon your relationship with open door is that they are OHP clientele only.

229

Haughton

Responds that yes, it is correct and comments that they are only OHP contracts.

235

Bates

Asks questions about clinics that are full what then do they do.

240

Haughton

Responds about how the clinics work being full.

250

Westlund

Re-asks his original question about folks getting turned away when clinics are full.

290

Haughton

Retracts her previous yes, and elaborates her answers.

295

Westlund

If they have the capacity they will, but it is not an emergency room.

300

Haughton

Responds with a yes and continues presentation.

315

Rep. Monnes Anderson

Asks if she foresees CareOregon picking up any more baby boomers.

320

Haughton

Responds about the baby boomers.

333

Heatherington

Responds that when they are open for enrollment they are open for all categories and when they are closed they are closed for all categories.

357

Haughton

Continues presentation.

365

Chair Westlund

Asks is the age breakdown going to be fairly consistent with the rest of the plans.

393

Haughton

Continues presentation and goes over the rest of (EXHIBIT B).

TAPE 26, B

002

Rep. March

Asks if Curry County is served.

010

Heatherington

Responds to services in Curry County.

028

Heatherington

Wraps up his presentation and introduces Dean Andretta, CFO for Mid-Valley IPA

038

Andretta

Introduces himself and give an overview of his organization and starts presentation. (EXHIBIT C)

102

Chair Westlund

Asks how you manage that portion of your costs.

103

Andretta

Responds about the portions of costs and where they go.

105

Chair Westlund

Asks how often that is negotiated, and that they are then the ones taking the risks.

119

Andretta

Responds to the risks that they are taking and elaborates.

121

Chair Westlund

Asks if these rates are based off of RVU’s (Relative Value Units)

125

Andretta

Answers question about RVU’s.

132

Rep. Kruse

Asks for more clarification on risks and how they are categorized.

153

Andretta

Answers questions about categorizations.

160

Rep. Kruse

Asks if they are reimbursing based on the way they conduct their business.

169

Andretta

Responds yes and elaborates about reimbursements.

180

Rep. Kruse

Asks why Kaiser is excluded.

185

Andretta

Responds about why Kaiser is excluded.

192

Rep. Merkley

Asks for definitions on Type A and Type B hospitals.

199

Andretta

Responds with the definitions of Type A and Type B hospitals.

208

Heatherington

Gives more detail about Type A and Type B hospitals.

224

Rep. Kruse

Asks if they have any critical access hospitals.

226

Andretta

Responds no.

233

Rep Bates

Asks if they have anything in place to regulate hospital costs.

239

Andretta

Responds with a yes, and elaborates.

295

Chair Westlund

Would like Andretta to repeat in a more succinct way.

298

Andretta

Responds with more clarification.

219

Chair Westlund

Asks what did they do to drive that denial rate.

323

Andretta

Responds about denial rates.

342

Chair Westlund

Asks how much of that 13% actually received treatment.

347

Andretta

Responds about the 13% that actually received treatment.

371

Chair Westlund

Asks if these are health plan patients and how much get shifted to commercial private pay.

375

Andretta

Responds about commercial private pay.

385

Chair Westlund

Asks how much of this comes back to you in contract negotiations and who actually pays for this.

389

Rep. Merkley

Relates a personal experience and asks  if the patient is not really told if this visit to the emergency room is going to be covered or not what are they to do.

418

Andretta

Responds by saying if the physician told them to come in, it will be covered.  And elaborates in more detail.

TAPE 27, B

020

Heatherington

Give more elaboration on Rep. Merkley’s question.

035

Andretta

Comments that they also pay for the initial assessment of the patient and the rest would be uncovered if the hospital does not decide to provide the service.

045

Rep. Tomei

Asks if the patient does go to the hospital inappropriately, does the hospital absorb that expense.

050

Heatherington

Comments that it depends if the hospital decides to provide the service.

054

Rep. Anderson

Asks if they do an exit survey essentially to see when someone went and whether or not they needed emergency services and then work with the patients so they don’t do that again.

062

Andretta

Responds about exit surveys and elaborates about people using the emergency rooms in inappropriate ways.

074

Rep. Bates

Wants to flesh ideas being presented and elaborates his point.  Asks what his experience is in seeing a drop in usage of the emergency rooms.

092

Andretta

Responds by saying since they took over the emergency rooms it has dropped by 20%.

102

Rep. Anderson

Asks how much farther this rate can drop.

108

Andretta

Comments that they may be able to drop it up to 50%, but feel that they have a long way to go.

115

Rep. Merkley

Makes comments to Rep. Bates that he would like to further discuss this emergency room information.

128

Andretta

Continues presentation.

155

Chair Westlund

Asks if they are dropping out March 1, 2003 and ask if they know of anyone who is not.

160

Andretta

Responds by saying yes, and continues presentation.

180

Rep. Monnes Anderson

Asks for more clarification on slide fourteen of (EXHIBIT C).

185

Andretta

Gives clarification.

190

Rep. Merkley

What happened to the  nineteen percent of your members March 1, 2003 that are part of the standard plan.

195

Andretta

Comments that he doesn’t have an answers, but will do all they can to see that patients have coverage.

215

Rep. Merkley

Asks more questions about those that will not have coverage after March 1, 2003

218

Rep. Bates

Comments that they will not have pharmaceutical coverage either.

222

Andretta

Continues presentation on slide 17.  (EXHIBIT C)

310

Chair Westlund

Asks what percent of primary care physicians participate in your plan.

315

Andretta

Responds by saying 100%.

318

Rep. Merkley

Have you talked about other solutions about that might be implemented and elaborates.

332

Andretta

Responds by saying they have looked at all the possibilities before deciding to pull out March 1, 2003.

336

Rep. Merkley

Comments that this now becomes a major issue for us to contend with.

342

Chair Westlund

Are you working with the large drug programs to help those dropped.

348

Andretta

Responds yes.

352

Chair Westlund

Asks for those eligible in your area, how many are truly enrolled.

385

Andretta

Responds with numbers of people enrolled.

399

Rep. Bates

Asks questions about groups pulling out.

TAPE 28, A

 

 

 

402

Andretta

Answers.  Continues presentation.

026

Rep. Anderson

Asks if there is there a reserve that the physicians have contributed to.

035

Andretta

Yes, they are non-profit and physicians pay $300.00 to belong.

043

Rep. Anderson

Asks if you are putting $300 in to break even or make a little.

046

Andretta

Responds by saying the $300 is for them to belong.

050

Rep. Anderson

Are you subsidizing the rest of your care with pharmacy costs.

052

Andretta

Responds about subsidizing.

084

Rep. Kruse

Asks if they are experiencing a shortage in OB’s

085

Andretta

Responds.

093

Heatherington

Make additional comments.

111

Rep. Kruse

Comments

 

Chair Westlund

Closes informational meeting and adjourns 4:55 pm

 

 

EXHIBIT SUMMARY

 

A – Informational – Managed Care, Private Sector of Medicaid in Oregon, Jeff

       Heatherington 3 pp  

B – Informational – Managed Care, Care Oregon Guide,  54 pp

C – Informational – managed Care, Overview of Mid-Valley IPA, Dean Andretta,  9 pp