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