HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM

March 27, 2003 Hearing Room 50

3:00 PM Tapes 73 - 74

MEMBERS PRESENT: Rep. Ben Westlund, Chair

Rep. Steve March, Vice-Chair

Rep. Jeff Kruse

Rep. Jeff Merkley

Rep. Alan Bates

MEMBERS EXCUSED: Rep. Randy Miller

Rep. Susan Morgan, Vice-Chair

STAFF PRESENT: Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

ISSUES HEARD: Informational Meeting

“Marion Polk Community Health Plan’s Administrative Service Organization Model”

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 73, A
005	Chair Westlund	Calls meeting to order and opens the informational meeting at 3:00 p.m.
INFORMATIONAL MEETING
020	Jan Buffa	CEO, Marion Polk Community Health Plan (MPCHP). Offers a PowerPoint presentation with prepared materials describing how their health plan and the Oregon Health Plan provide services. (EXHIBITS A, B, C)
177	Chair Westlund	Indicates this is a key component and it is very impressive the way this program is managed.
180	Buffa	Explains how they function with such a small staff.
221	Rep. Bates	Notes a wonderful job is being done with cost controls which has taken away the adverse relationships between physicians and insurance companies
255	Buffa	Describes again how they make the process work
274	Chair Westlund	Asks for definition of an ancillary cost.
280	Buffa	Answers providers that are not physicians and continues to explain with tight staffing and medical management software they are able to continue to provide services.
300	Rep. Merkley	Asks for an overview of their software.
308	Buffa	Answers it is the wide area network.
354	Chad Negel	Chairman, Marion County Health Plan. States that this network is available to every physician.
360	Chair Westlund	Asks if there are any further incentives.
365	Buffa	Responds yes and explains the process of the Independent Physicians Association (IPA) membership.
400	Berkobien	Asks if there is a minimum amount of clients that each physician should serve.
TAPE 74, A
003	Buffa	Responds yes but it is difficult to monitor.
062	Rep. Bates	Asks what is preventing the open card patients from being accepted.
066	Buffa	States they have accepted these people in the past.
077	Negel	Explains not all open card members are eligible for the health plan.
106	Buffa	States they have held open the open enrollment.
122	Chair Westlund	Asks how well do the other plans know this population
125	Buffa	Responds that they do know them well.
129	Rep. Bates	Asks if family care is included.
135	Negel	Answers it is illegal to market the health plan to the public.
143	Buffa	Responds to the number of the population recruited.
157	Rep. March	Asks if he has a number of those in the ineligible categories.
160	Buffa	Expresses no idea of the percentages of the population but could research and email the numbers.
165	Negel	Notes the population on the health plan does have Primary Care Physicians (PCP) assigned to them.
167	Buffa	States there are twenty-five percent that is not eligible.
190	Jeff Heatherington	Family Care. Indicates less than two percent are not enrolled in a health plan and some are in transition.
227	Buffa	Comments that they are open for open enrollment but the Office of Medical Assistance Program (OMAP) is behind in processing applications and offers information on the prescription cuts.
267	Chair Westlund	Asks how many patients are involved.
274	Buffa	Answers one hundred and twelve.
299	Rep. March	Asks for the costs per person for methadone patients per year.
306	Buffa	Responds in addition to methadone treatments the patients need to be managed.
317	Chair Westlund	Notes twenty-three hundred dollars a year.
322	Berkobien	Comments that he has heard a booking in jail cost approximately the same.
329	Buffa	Offers the cost of two clients in the hospital.
338	Rep. Merkley	Asks how many were in because of overdoses.
341	Buffa	Comments about a client coming off of methadone and the price of hospital care.
352	Rep. Bates	Offers information on a patient becoming infected from shooting up when off methadone and the cost of hospital fees.
368	Buffa	Comments about those who lost their methadone treatment.
370	Negel	Expresses the analysis of the costs of the Marion Polk Health Plan.
TAPE 73, B
030	Rep. March	Asks for clarification on the annual statewide figures.
033	Negel	Responds that figure was a mid biennial figure.
034	Chair Westlund	States the key is to know they have good solid data.
051	Rep. March	Notes we know that five percent is different and what we need to do is get OMAP to run statistics of the open card population.
065	Rep. Bates	Explains some counties have managed care and some do not.
070	Chair Westlund	States OMAP will not have as good of data as MPCHP.
081	Buffa	Offers if OMAP would give them the figures they could produce the data.
090	Chair Westlund	********RECESS – TECHNICAL PROBLEMS*******
109	Michael Roar	Salem Doctor. Offers information on the unmanaged population indicating that delegation of management of the following services will save costs: Utilization management Chemical dependency and mental health Authorization management for hospital and physician services Case management Payment and adjudication of claims Member services and coordination of benefits Transfer of third party liability Disease management
115	Chair Westland	Asks if the chemical dependency program is already provided by OMAP.
170	Buffa	Answers yes this is inside the OMAP umbrella.
180	Roar	Responds if there is an effective management in place it would not be necessary to delegate it out.
195	Berkobien	Asks with coordination of benefits are you able to pull the data to tell how much you receive from that portion of clients.
202	Negel	Answers around two to three dollars per member per month.
204	Chair Westlund	Asks if the black box concept from HIPAA (Health Insurance Portability Accountability Act) on the centralized data system has been considered.
220	Roar	Responds having no knowledge of that but it sounds like a good idea but states budget predictability is what is important.
251	Rep. Merkley	Asks if these individuals are being put in this structure within the federal rules pertaining to open card individuals.
264	Roar	Responds regarding open card patients and how it works.
306	Rep. Merkley	Asks would an open card patient have a primary care provider.
314	Roar	Responds he does not know the answer.
316	Chair Westlund	Asks for clarification about waivers.
329	Rep. Merkley	Asks if the Federal Law requires the option to have an open card or restricts the number of physicians a patient could see.
349	Rep. Bates	Responds the need to research the issue.
374	Roar	Describes the steps to achieve the delegation process and how it would be handled with managed care contracts and services being provided locally.
TAPE 74, B
043	Rep. Bates	Asks if the same system is being using on commercial plans.
047	Roar	Responds they are using the same technology for all contracts.
053	Rep. Bates	Asks if they could take over the eligibility enrollment process.
056	Roar	Responds affirmatively.
060	Rep. Bates	Asks what part of OMAP could MCPHP take over.
065	Roar	Responds that they could manage all the components but it wouldn’t necessarily be easy.
073	Rep. Bates	Asks if it would be less expensive for the state.
095	Roar	Answers they could not take over all that OMAP does but what they could would be more cost effective.
102	Rep. March	Asks about their Obstetrics and Gynecology (OBGYN) program.
106	Buffa	Responds to the rise in the cost of malpractice premiums.
134	Chair Westlund	Asks how the recommendations we have made impact your PBM (Pharmacy Benefit Manager).
142	Buffa	States the contractors are going to go through the committee’s report and supply a written response.
197	Chair Westlund	States they would like to see this addressed at the meeting on Monday.
215	Rep. Bates	Comments on what the stakeholders group want to see happen.
231	Chair Westlund	States you are the backbone of the delivery system so it has to work.
241	Buffa	Answers negotiations with PBM have been a learning experience.
271	Chair Westland	Calls informational meeting to a close and adjourns committee meeting at 4:48 pm

EXHIBIT SUMMARY

A – Informational, A Study of Alternative Rate-Setting Approaches for Oregon Health Plan, Jan Buffa, 12 pp

B – Informational, Marion/Polk Community Health Plan, Jan Buffa, 10 pp

C – Informational, Performance Health Technology Packet, Jan Buffa, 7 pp