HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM

 

 

April 01, 2003 Hearing Room 50

3:00 PM  Tapes 77 - 78

 

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                     

                                                   Invited Testimony

                                                      Kelley Kaiser, Tuality Health Alliance

      Pam Mariea, Intercommunity Health Network

 

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 77, A

005

Chair Westlund

Calls the committee meeting to order introduces our guests and opens the informational meeting.

INFORMATIONAL MEETING

025

Kelley Kaiser

CEO, Intercommunity Health Network.  Informing the committee on the role of the Physician Hospital Community Organization as it relates to Health Network administering the Oregon Health Plan. Presents (EXHIBITS A and B).

044

Pam Mariea

Director, Tuality Health Alliance.  Explains the different services provided.

115

Chair Westlund

Asks what geographical area is being served.

125

Mariea

Answers Western Washington County.

145

Kaiser

Informs the committee on the demographics and offers numbers of clients being served and employees serving.

203

Rep. Bates

Asks why the fee for service number is so large in Washington County.

205

Kaiser

States they have been looking into that issue and are not sure.

221

Rep. Bates

Notes it is counter intuitive to a degree.

222

Kaiser

Responds concurring and offers reasons that might possibly be affecting the numbers.

230

Rep. Bates

Asks if the glitch is in the state part of the system.

232

Kaiser

Answers when we are out in the field offices talking with the enrollment people we get a variety of reasons.

241

Rick Berkobien

Asks if there has been a drop in getting people to enroll.

248

Mariea

Answers it is not what was expected.

260

Kaiser

Notes in Lincoln County there is no managed care.

269

Rep. Bates

Asks if those like dialysis patients that heavily utilize health care are the ones that need managed care.

280

Kaiser

Answers and states they haven’t been addressed in the contract.

282

Rep. Bates

Asks if it could be done more efficiently than having them out in fee for service.

291

Kaiser

States in our experience managed care gives stability to this environment and works well for this population.

300

Kaiser

Notes there are issues around this.

385

Rep. Bates

States this needs to be on the table for discussion.

312

Kaiser

Comments that the majority of their primary care providers are within the system.

314

Rep. Bates

Asks if the Good Samaritan Health Plan is the one in the Lebanon-Corvallis area.

316

Mariea

States yes and offers the hospital names.

323

Rep. Bates

Asks if the friction between the plan and the hospital has gone away and asks about the blended rate.

344

Kaiser

Responds the majority of the primary care physicians are a part of our system and states there is no animosity and states that is the key to our success.

374

Mariea

Notes increasing the number of contracts held helps physicians be invested in the Medicare and Medicaid product.

390

Chair Westlund

Inquires the ownership of a hospital in Lincoln County.

395

Kaiser

Answers they have management contracts and explains how it works.

TAPE 78, A

002

Chair Westlund

Asks what are the unique characteristics of Lincoln County that makes it cost prohibitive.

015

Kaiser

Responds there is not a lot of managed care there it is strictly fee for service.

043

Rep. Bates

Notes Lincoln County may have a special problem with high Medicaid and Medicare with reimbursement being questionable and asks if managed care could work there.

052

Chair Westlund

Notes with fee for service they are getting a lower reimbursement rate.

080

Rep. Bates

Asks if both hospitals are A and B hospitals.

086

Kaiser

Responds yes that they are both A and B hospitals.

090

Mariea

Responds to the focus of enrollment process in Lincoln County.

117

Chair Westlund

Asks what is the term when a physician is associated with the hospital.

123

Kaiser

Responds if a physician is on staff they would receive medical staff privileges.

124

Chair Westlund

Asks if it is in the physician’s best interest.

125

Kaiser

States they would probably prefer managed care.

132

Rep. Greenlick

Asks what does managed care really mean.

165

Kaiser

Responds what they try to do to create the process so it works for the physicians in that community.

085

Rep. Greenlick

Asks if they find differences between the counties and the willingness of the physicians.

197

Kaiser

Answers it really depends on the way it has been done in the past and some are more willing than others.

210

Chair Westlund

Notes experience in a certain area makes a difference.

218

Rep. Greenlick

Concurs that it is a historical issue for most counties.

238

Mariea

Adds it takes leadership from strong community minded physicians.

263

Berkobien

Asks what kind of policy barriers do we have in Oregon now do to increasing managed care.

279

Rep. Kruse

Asks if the failure of SureCare poisoned the well.

286

Kaiser

States it helped to learn what went wrong and how we can change things in the future.

305

Rep. Bates

Shared a story about his area when people became afraid to take the risks.

315

Kaiser

Notes the fear of risk in the provider community in Lincoln County is very large.

316

Rep. Kruse

Comments that is what happened to SureCare in Lincoln County.

318

Rep. Bates

Notes that is similar to what happened to Jackson County.

321

Mariea

Comments that they are definitely backing away from risks that Oregon Health Plan is the only full risk contract they have now.

329

Rep. Kruse

Asks who is assuming the risk.

332

Mariea

Responds the hospitals.

340

Rep. Bates

Asks if they have a Medicare Choice plan.

345

Mariea

Responds no they contract out for that.

354

Chair Westlund

Asks how the new recommendations will effect their organizations.

370

Mariea

Responds they are not looking for risk but they are managing the care of those entering the hospitals under their zip code area.

396

Rep. Bates

Asks how is the population managed when patients could go to hospitals outside your system.

TAPE 77, B

003

Mariea

Responds they manage this with the physician network.

024

Chair Westlund

Asks if they could absorb thirty-five hundred.

025

Mariea

Responds affirmatively.

031

Rep. Greenlick

Asks who will accept the risk for the thirty-five hundred.

035

Mariea

Notes that they would be fully capitated.

043

Rep. Bates

Asks if the non-enrollment managed care are seen in the hospitals.

046

Mariea

Answers yes in the emergency department and specialists are seeing all of those that come.

050

Rep. Kruse

Notes patients are not even asking for care than they end up in the emergency at the hospitals.

053

Mariea

Answers they are suppose to only be taking mandatory zip code open enrollment patients.

058

Rep. Bates

Asks if these people are signed up for managed care.

060

Mariea

Answers the hospitals have agreed to provide for mandatory zip managed care.

078

Rep. Bates

Offers a scenario to better understand what is being talked about.

091

Mariea

Notes the workers are able to override the system.

094

Chair Westlund

Asks what they can do to help them.

097

Kaiser

Responds that they are in support of keeping the Oregon Health Plan and notes anything they can do to help keep the infrastructure in place would be welcomed.

114

Mariea

Responds they will get back to Chair Westlund with a list of things that would be nice to see done and thanks the committee for making them feel valuable in the process.

123

Chair Westlund

States what is evolving is a new sense of commitment.  Closes informational meeting and adjourns committee meeting at  4:20 p.m.

 

EXHIBIT SUMMARY

 

A – Informational, prepared testimony, Kelly Kaiser, 57 pp

B – Informational, prepared testimony, Kelly Kaiser, 8 pp