HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM

 

 

April 03, 2003 Hearing Room 50

3:15 PM Tapes  82 - 83

 

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. Laurie Monnes Anderson

                                                Rep. Carolyn Tomei

 

STAFF PRESENT:                  Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

ISSUES HEARD:                     Informational Meeting

Recommendations on Changes to the OHP from the Perspective of Health Plans’ Medical Directors

                                                Invited Testimony

Joel Daven, MD, Douglas Co. IPA

David Labby, MD, CareOregon

Rick Wopat, MD, 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 82, A

003

Chair Westlund

Calls the meeting to order and opens the informational meeting.

INFORMATIONAL MEETING

015

Rick Berkobien

Gives an explanation of (EXHIBIT A) presented at the dais.

065

Chair Westlund

Calls the witness forward for the invited testimony.

070

Dr. Joel Daven

Introduces himself from Douglas County IPA and begins testimony.

102

Dr. David Labby

Introduces himself from CareOregon, presents testimony (EXHIBIT B)  and begins presentation.

142

Dr. Rick Wopat

Introduces himself as a family physician in Lebanon and also as Director of InterCommunity Health Network.

173

Daven

Begins presentation.

271

Labby

Begins presentation.

319

Rep. Greenlick

Asks how do they pay the hospitals.

322

Labby

Responds about how they pay the hospitals.

325

Chair Westlund

Asks if it is mandatory.

331

Labby

Responds and continues presentation.  Presents (EXHIBIT C)

TAPE 83, A

048

Rep. March

Asks if you have noticed a higher instance of asthma in the youth in Multnomah County.

056

Labby

Responds that he does not have that data at his finger tips, but elaborates about some of the studies done in that area.

063

Rep. March

Asks if he has been involved in the studies on chronic pain.

071

Labby

Responds about his role in the chronic pain area.

090

Rep. Bates

Your organization is different because it is spread across the state and most organizations are community oriented and feels that’s how they make it work, you seem to be different do you feel that you have a relationship with any of your providers that is close even though you are statewide on the point of view of being efficient and elaborates more.

096

Labby

Responds that he feels there is a difference.

117

Berkobien

Asks if CareOregon is doing anything to look at the best practice uniform treatment.

125

Labby

Responds to the question on best practice uniform treatment.

149

Wopat

Begins presentation and presents testimony (EXHIBIT D).

232

Chair Westlund

Asks that everyone in the room looks at the recommendations as a base and just a format to make this all come together comments that this is not an end product and give more elaboration.

275

Wopat

Makes comments and continues his presentation.

308

Rep. Bates

Makes comments about the “Carve Out” paragraph in (EXHIBIT D).

345

Wopat

Responds to the “Carve Out” paragraph and continues presentation.

380

Rep. Tomei

Does not understand how rebates work and how they are scientifically based asks for clarification.

390

Wopat

Responds with clarification on rebates.

TAPE 82, B

015

Rep. Tomei

She finds this very interesting, as she has heard is how important rebates are and you are saying to stay away from them.

025

Wopat

Elaborates his feelings on rebates.

028

Rep. Greenlick

Comments that there is a feeling on a drug for drug basis, any drug, name the drug, the state paying for a Medicaid drug can get the best price per unit for that drug and if you take that assumption as a given, the state can get a better price than you can, and elaborates in great detail.

035

Wopat

Responds to comments about rates for drugs.

048

Rep. Bates

Comments that what we are trying to do here is get the best of both worlds and elaborates.

062

Wopat

Comments attempting to carve out is very problematic.

065

Rep Greenlick

Asks why it seems that  Wopat doesn’t care.

070

Wopat

He is not going to worry about the costs and responds that of course he cares and explains why he feels the way he feels.

082

Rep. Bates

Comments that it seems that we are mis-communicating, and states that we are talking about purchasing and you would still be purchasing those drugs at a lower price, but would be still be at risk with a capitation rate based on that lower price and will still be at risk if you do not manage those drugs.

085

Wopat

Reads from the recommendations what his understanding is of what they say.

087

Rep. Bates

Comments that he guesses we were not clear in our communication about carve outs.

091

Wopat

When you are talking to me about administrative fee, to me it clearly says carve out the cost of the drugs, and elaborates.

095

Chair Westlund

Comments that we are not going to change rebate policy, you employ a PBM that utilizes the practice that you are speaking against.

100

Rep. Greenlick

Comments on the paragraph stating that the most important factor in price is a physician having a stake in the cost and comments on his study of physicians for years and states what he is hearing is that he can’t be socially responsible as a clinician unless you have a financial incentive in being socially responsible, asks if that  is what he is saying.

125

Wopat

Responds by commenting about what he is trying to say.

140

Vice Chair March

Asks if the state gathers a rebate we may have to return that at some point.

147

Daven

Responds that he will be looking into that.

152

Rep. Merkley

Makes comments about the rebates and asks if the state was negotiating for a rebate, those would not be tied into making that drug a preferred drug or so forth, and asks if it is fundamentally different.

162

Rep. Bates

State the goal of the statement that was made.

170

Wopat

Makes comments about formulary.  Continues presentation.

287

Rep. Merkley

Asks why is it that in the commercial world that something like the prioritized list has not been adopted.

298

Wopat

States his opinion on the prioritized list in the commercial world.

327

Daven

Comment on the uniqueness of the Oregon Health Plan.

343

Wopat

When he says he would use the Oregon Health Plan, he makes his known that he can pay for that.

353

Labby

Makes comments about making treatment more “scientific.”

381

Rep. Greenlick

Comment that he loves all of their recommendations and wonders if they have a politically feasible way to raise the kind of money it would take to fill your recommendations.

006

Wopat

He believes that we will not be able to maintain this level without funds, we need to look at additional tax revenue and he realizes measure 28 failed, and thinks the alcohol tax would work as additional revenue as well, he elaborates in more detail

028

Labby

One of the issues we need to figure is how do we make more of the communities that don’t have any form of organization or manage care be able to move in the direction of being a cohesive medical community.

050

Daven

Comments that most doctors are support some of the items on the prioritized list and elaborates.

058

Wopat

Comments about cutting A and B hospitals and shares that they look at the costs of doing that and elaborates.

095

Rep. Merkley

Thanks the panel for their testimony and described the task they started with and elaborates.

102

Vice Chair March

Calls meeting to a close and adjourns 4:50 pm

 

 

EXHIBIT SUMMARY

 

A – Informational, OHP recommendations, staff, 2 pp

B – Informational, prepared testimony, David Labby, 8 pp

C – Informational, handbook, David Labby, 97 pp

D – Informational, prepared testimony, Richard Wopat,  5 pp