HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM

 

 

April 02, 2003 Hearing Room 50

3:15 PM  Tapes 79 - 81

 

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

 

GUEST MEMBERS:               Rep. Mitch Greenlick

                                                Rep. Carolyn Tomei

                                                Rep. Laurie Monnes Anderson

 

STAFF PRESENT:                  Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

ISSUES HEARD:                     Informational Meeting

                                                   Invited Testimony Only

                                                      “Ensuring the stability of the OHP delivery system from the FCHP

                                                           Administrator perspective”

                                                      Bill Murray, DOCS Health Plan

                                                      Bill Guest, Cascade Comprehensive Care

                                                      David Ford, CareOregon

 

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 79, A

003

Chair Westlund

Calls committee meeting to order at 3:00 p.m.  Opens informational meeting.

INFORMATIONAL MEETING

045

Bill Guest

President, Cascade Comprehensive Care.  Submits prepared materials and presents testimony on the value of fully capitated health plans (EXHIBIT A).

193

Rep. Greenlick

Notes allowing physicians to have a sense of being in charge of clinical situations is a powerful tool.

214

Guest

Responds to how they try to change the behavior of the physicians.

239

Rep. Greenlick

States they do make decisions on financial issues.

243

Guest

Responds explaining where a physician makes a decision based on a financial risk.

270

Rep. Greenlick

Comments on physician’s being rewarding for making the right decision.

278

Guest

Offers information on Pharmacy Benefit Management (PBM).

322

Rep. Bates

Asks if they have their PBM’s audited and how often.

332

Guest

Responds they do every month.

391

Chair Westlund

Asks if this is interfering with the actual drug purchase.

402

Guest

Responds to the fact of interference.

TAPE 80, A

024

Rep. Greenlick

Responds to the chart and states it looks like it was flat and dropped before the pharmacists showed up.

031

Guest

Responds to the costs of generic drugs.

047

Rep. Bates

Comments on the number of prescriptions per person per year.

057

Guest

Responds to the plan being the highest average in the state and offers budget figures.

090

Chair Westlund

Asks what percentage is being received for rebates on drugs.

101

Guest

Responds you do not get rebates on generic drugs.

105

Chair Westlund

Notes other companies state they are getting up to eleven percent.

116

Guest

Responds with the rebate percentages and utilization reductions.

147

Rep. Greenlick

Asks for clarification of the costs of brand drugs versus generic drugs.

167

Rep. Bates

Asks what does your new PBM do to get to a higher generic rate.

169

Guest

Responds they offer better information on new and improved drugs.

178

Rep. Bates

Asks if the PBM sends the doctors out in the field to offer education about generic and brand drugs.

185

Guest

Responds how the system works.

191

Rep. Monnes Anderson

Asks if there is a lot of new eligibles and what percentage of the organization is Oregon Health Plan (OHP).

202

Guest

Responds that 100% of their enrollees are OHP.

211

Chair Westlund

Asks how many of your enrollees are fee for service.

213

Guest

Responds with the numbers.

219

Rep. Monnes Anderson

Asks how many of the others are HMO’s.

225

Guest

Responds that there is no other commercial care in their county.

288

Rep. Greenlick

Comments on the check and balances in the fee for service side.

301

Chair Westlund

Comments that it doesn’t matter who does it as long as it is better.

313

Rep. Bates

Asks if they have control over transportation costs and if not who pays for it.

324

Guest

Responds a patient needs to have a good reason to go out of the area for service.

337

Rep. Bates

Asks when the patient decides to go to Portland who pays for that transportation.

350

Bill Murray

Comments they are only on line for emergent transportation.

378

Murray

CEO, Doctors of the Oregon Coast South (DOCS).  Introduces himself and offers prepared material and describes this physician owned organization (EXHIBIT B).

TAPE 79, B

181

Rep. Bates

Asks if there is a better way of setting rates.

186

Murray

Responds the two year rate plan is a complex problem.

225

Guest

Comments that they were hoping for a third party to audit the rate process.

243

Rep. Greenlick

Asks why we can’t let them set their own rates.

256

Rep. Bates

Notes competitive bidding is a difficult process.

262

Murray

Comments to the issue of physical and mental health.

342

Rep. Kruse

Asks if they have any obstetricians left and states there is only one in their county.

345

Murray

Responds they do have four.

357

Rep. Greenlick

Asks questions about the referral services.

360

Murray

Responds how the referral system works.

402

David Ford

Chairman, CareOregon.  Introduces himself and informs the committee on his background in the healthcare realm and the process and services of CareOregon.

TAPE 80, B

001

Bill Murray

Continues.

096

Chair Westlund

Comments to the infrastructure and integrity of the healthcare program.

104

Ford

Offers information on the rate setting process.

198

Rep. Greenlick

Asks if three hundred thousand dollars could be reinsured.

203

Ford

Responds it would be charged as catastrophic.

249

Rep. Monnes Anderson

Asks how many members are in CareOregon.

250

Ford

Answers twenty-one thousand.

 

Rep. Monnes Anderson

Asks how many are fee for service.

 

Ford

Answers in the Tri-county area there is forty-seven thousand.

257

Rep. Monnes Anderson

Asks how many HIV patients are there.

260

Guest

Responds with the number of HIV patients and comments on the unevenness of insurance.

279

Ford

Offers explanation and states the difference between the rural and urban counties.

284

Rep. Monnes Anderson

Asks about the difference in the continuity of care.

292

Ford

Responds to the turnover and keeping networks together.

296

Rep. Monnes Anderson

Comments that case management is very important in the process.

300

Chair Westlund

Asks why bother with Klamath County.

309

Ford

Comments they will be looking at that issue and states these patients come through the community health clinic.

325

Chair Westlund

Asks if Cascade could take over some of the patients from CareOregon.

328

Guest

Comments they would love to but they have some of the same providers.

339

Ford

Notes some of the counties are under hardship.

347

Rep. Kruse

Comments on there being two care plans in two counties that are very close and comments about the difficulties.

380

Chair Westlund

Asks if there is anything that the committee is not doing that they could do for them.

385

Guest

Responds to their needs and states with local people that know the patients the needs are better met.

TAPE 81, A

003

Chair Westlund

Asks if they capitate physicians on an individual basis.

012

Guest

Answers they capitate all primary care physicians.

035

Ford

Notes the physicians tend to self police.

341

Chair Westlund

Reminds the witness that we are fourteen million behind.

045

Ford

Comments on knowing the areas where money can be saved.

053

Guest

Notes the money earned.

056

Murray

Comments we need to specialize and work on the things that work well.

080

Chair Westlund

Comments on the unique community foundation that makes this process work and states there is a possibility of losing it.  Calls informational meeting to a close and adjourns committee at 4:49 pm.

 

EXHIBIT SUMMARY

 

A – Informational, prepared testimony, Bill Guest, 10 pp

B – Informational, prepared testimony, Bill Murray, 9 pp