HOUSE COMMITTEE ON

AUDIT & HUMAN SERVICES BUDGET REFORM

 

April 07, 2003 Hearing Room 50

3:15 PM Tapes  84 - 87

 

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

                                                Rep. Gordon Anderson

 

STAFF PRESENT:                  Rick Berkobien, Committee Administrator

Kelly Fuller, Committee Assistant

 

ISSUES HEARD:                     INVITED TESTIMONY ONLY

Context for the Mercer Project and Introduction of Mercer Panel Bruce Goldberg MD, Office of Oregon Health and Policy Research

 

Review of Mercer Report

James Matthisen, Mercer Human Resource Consulting

 

Implication of Current Environment in Oregon and Nationally

Steve Schramm and Stephanie Davis, Mercer Human Resource Consulting

 

OHP Fully Capitated Health Plan Panel Comments on Mercer Report

Bill Murray, DOCS Health Plan

Dean Andretta, Mid-Valley IPA

 

Question & Answer: on House Audit Committee's Report

James Matthisen, Steve Schramm and Stephanie Davis

Mercer Human Resource Consulting

Bill Murray, DOCS Health Plan

Dean Andretta, Mid-Valley IPA

 

MEASURES:                                     

HB 2537 Public Hearing

HB 2559 Public Hearing

HB 2560 Public Hearing

HB 2641 Public Hearing

HB 2562 Public Hearing

HB 2829 Public Hearing

HB 2189 Public Hearing

 

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 84, A

003

Chair Westlund

Calls the meeting to order and opens for Public Hearing.  Hands the gavel over to Rep. Kruse to tap in and tap out the house bills for the public hearing.

HB 2537 PUBLIC HEARING

031

Rep. Kruse

Opens HB 2537

032

Rep. Kruse

Closes HB 2537

HB 2559 PUBLIC HEARING

033

Rep. Kruse

Opens HB 2559

034

Rep. Kruse

Closes HB 2559

HB 2560 PUBLIC HEARING

035

Rep. Kruse

Opens HB 2560

036

Rep. Kruse

Closes HB 2560

HB 2641 PUBLIC HEARING

037

Rep. Kruse

Opens HB 2641

038

Rep. Kruse

Closes HB 2641

HB 2562 PUBLIC HEARING

039

Rep. Kruse

Opens HB 2562

040

Rep. Kruse

Closes HB 2562

HB 2829 PUBLIC HEARING

041

Rep. Kruse

Opens HB 2829

042

Rep. Kruse

Closes HB 2829

HB 2189 PUBLIC HEARING

043

Rep. Kruse

Opens HB 2189

044

Rep. Kruse

Closes HB 2189

045

Chair Westlund

Closes the public hearing.

INFORMATIONAL MEETING

050

Chair Westlund

Opens the informational meeting for invited testimony, and calls the first witness.

060

Bruce Goldberg, MD

Introduces himself from Office of Health Policy and Research and begins his testimony.

090

Goldberg

Invites the next three witness to testify.

095

James Matthisen

Introduces himself from Mercer Human Resource Consulting.

100

Stephanie Davis

Introduces herself from Mercer Human Resource Consulting.

105

Steve Schramm

Introduces herself from Mercer Human Resource Consulting.

108

Matthisen

Presents testimony and begins presentation. (EXHIBIT A).

150

Rep. Greenlick

Comments that there are lots of different definitions of equity and asks did you really discuss what version of equity that you mean.

159

Matthisen

Responds that they did try to put more flesh around the names for criteria in the full report.

175

Rep. Greenlick

Are you talking about equity as in comparing physicians to hospitals.

183

Matthisen

Responds yes, physicians verses hospitals.

195

Rep. Greenlick

Wants more elaboration about the equity that they are referring to, asks do you mean I will be treated fairly if I have been given more.

197

Matthisen

Responds in more detail to the question.

125

Chair Westlund

Makes comments to clarify the questions of equity.

138

Rep. Greenlick

Makes additional comments.

244

Matthisen

Makes comments about some peoples comments about them not keeping pace and continues presentation.

TAPE 85, A

064

Chair Westlund

Looking at the Mercer report he is assuming that this category on page 7 shows some kind of weighting on a stronger recommendations or ability to accomplish and elaborates. (EXHIBIT A 4/1/03)

081

Matthisen

Responds to the question on page 7 of the Mercer of the report.

098

Rep. Greenlick

Asks if he could go across the top line of this page 7 and give more elaboration and help to define the assessments and share how utilization of service and unit cost got one check and ASO got two checks.

120

Matthisen

Explains the category about equity among providers.

130

Rep. Greenlick

Responds that’s not really the equity it is criteria of how closely controlled the reimbursement that the state does, asks is that your definition of equity.

135

Matthisen

Responds it is how much the method allows the equity goal to be influenced by the state.

148

Rep. Greenlick

Responds no, it is how much the actual reimbursement is determined by the state.

157

Matthisen

Responds, yes.

160

Rep. Greenlick

So that criterion should not be equity it should be the extend to which the state rather than somebody else determines the distribution of payments and elaborates.

162

Matthisen

Comment that there is a proceed problem with its current method.

170

Rep. Greenlick

Makes additional comments on page 7 of the report.

175

Matthisen

Responds yes, that is correct.

178

Rep. Greenlick

Comments that if you stack the deck so that one definition automatically gets a four and the other gets a one regardless of whether there is equity or not, then you have defined it that way.

184

Matthisen

Responds yes, that they have had to pick a context and elaborates.

201

Rep. Merkley

Asks if they thought about the equity verses providers as an option.

216

Matthisen

Responds no, not an explicit analysis and continues presentation.

287

Steve Schramm

Begins his testimony and explains (EXHIBIT B).

TAPE 84, B

027

Vice Chair March

Asks is there one state that might be doing stellar in any of these categories.

030

Schramm

Responds by listing the stellar states and continues presentation.

114

Rep. Greenlick

Asks if this just like the fee for services we use to have.

116

Schramm

Responds that yes, it is very similar to the old fee for service way of doing things.

120

Rep. Greenlick

Asks if they didn’t rate that high in administrative feasibility.

123

Schramm

Responds about the administrative feasibility and continues presentation.

212

Vice Chair March

Asks how long it took Tennessee to work through the process.

218

Schramm

Responds that it to Tennessee 18 months to negotiate with ASO.

227

Stephanie Davis

Makes comments about why other states went to an ASO and comments that we should look at what is working now and work on that.

272

Rep. Bates

Asks how you would go about setting capitation rates.

183

Schramm

Responds that they are the consultants to 20 – 28 programs right now and comments about the 3 points of data that the states use to make these decisions.

328

Rep. Bates

Asks how accurate they have been in the last couple of years.

332

Schramm

Responds about their accuracy in the last few years.

352

Rep. Greenlick

Asks if they risk just those rates.

356

Schramm

Responds that it is a policy adjustment.

363

Rep. Greenlick

Do you find that when you do risk adjustment it decrease you ability to predict accurately.

375

Schramm

Responds about risk adjustment models.

394

Rep. Greenlick

Comments that it really does improve your estimates.

002

Schramm

Comments what they believe about risk adjustments and describes the difficulty that they have.

TAPE 85, B

011

Davis

Makes comment about risk adjustment models.

024

Rep. Greenlick

Makes additional comments.

027

Rep. Bates

Asks his question from above again, as it was not clear before and re-asks how accurate their predictions have been.

050

Schramm

Responds that they usually hit within the range that is given to them as a model and comments that they try to set a wider range because of a lack of information and etc.

070

Vice Chair March

Thanks the witness for their testimony and ask the next witnesses to come up.

078

Bill Murray

Introduces himself from DOCS Health Plan and begins presentation.

120

Dean Andretta

Introduces himself from Mid Valley Individual Physicians Association and begins presentation.

151

Rep. Greenlick

Asks how they would define equity.

156

Murray

Responds with his definition of equity.

177

Andretta

Responds with his definition of equity and elaborates.

207

Vice Chair March

Opens the question and answer part of the meeting on the House Audit Committee Report.

216

Matthisen

Makes comments about how helpful the committee has been.

224

Rep. Bates

Asks Bill Murray if he is missing something in this process of capitation rates.

242

Murray

Responds to the question on capitation rates.

272

Chair Westlund

Comments that he is still confused on this chart on page 7 of the Mercer Report, the fee for service report scores higher, can you explain that.

288

Schramm

Responds on the issues that Mercer would have with that.

324

Chair Westlund

Appreciates him pointing this stuff out but he still looks at this thing and comments that the ASO is just kicking the RUV’s tail.

345

Rep. Greenlick

He thinks the value of this chart would be how you can rate these things.

379

Matthisen

Comments about the value of this chart and goes back over the part which describes equity among providers.

TAPE 86, A

003

Chair Westlund

On page two of the Mercer Report was there anything on the RFP that caused them to evaluate the current methodology.

016

Matthisen

Comments how they went about creating this report.

025

Chair Westlund

How is this relevant to me and help with our decision making process in here.

031

Matthisen

Comments again their charge was not to compare reports and comments about how they created it.

043

Rep. Bates

Comments that as he was looking at the report he asks where we want to go with the health plan, he sees that toward the end of the report it looks like they are dropping people out of the plan.  How do you get people in the plans to stay in the plans and what have other states done to keep people in the plans.

070

Davis

Describes the element that causes confusion that does not in other States.

158

Schramm

Address how they are getting more people into Managed Care Plans.

180

Chair Westlund

Comments about hearing the more general question on what other states are doing, asks what is happening Nationally.

188

Schramm

Comments about what is going on Nationally.

207

Chair Westlund

Asks if he can break that out away from the commercial end.

214

Schramm

Responds no, because his response was dedicated to Medicaid and elaborates.

221

Chair Westlund

Asks how many states have this model.

228

Schramm

Comments that it is very typical to have many health plans.

240

Chair Westlund

Asks if Oregon is fairly unique.

245

Schramm

Ultimately health care is local and in Oregon you have been able to find fourteen health plans and guarantee access and quality of care, do be a solution in search of a problem.

251

Chair Westlund

One of the keys to this is the local/regional intimacy relationships that are build and that’s why these things are working.

253

Rep. Bates

Comments that he thinks we have an exceptional program and was looking for a comment if we really are unique and if we are how do we go about sharing this.

278

Davis

Comments that most states goal was to have something like we have here today and elaborates.

332

Rep. Bates

Comments about one of the problems we are having here today and asks if other states are facing the problem of not having enough money to bring to the table.

350

Schramm

Responds absolutely, and elaborates.

389

Rep. Bates

Asks if he remembered what that particular population was.

397

Schramm

Responds yes, that it was associated parents for an SCHIP program.

TAPE 87, A

001

Rep. Bates

Asks if other states have tried to increase revenues in other ways.

004

Schramm

Responds yes, and makes comments about the ways that they are trying to increase revenues in other states.

016

Chair Westlund

Asks what has the states success been with these.

019

Schramm

Responds about the success rate.

026

Chair Westlund

Asks if there is a bit on negotiation going on and putting together some creative financing.

037

Schramm

Responds to the negotiations that he is aware of.

050

Chair Westlund

Calls meeting to a close and adjourns 5:42 pm

 

 

EXHIBIT SUMMARY

 

A – Overview of Mercer Report “A Study of Alternative Rate Setting Approaches for Oregon Health Plan Fully –Capitated Plans” presented by James Matthisen 4 pp.

B – Risk Continuum Models – presented by Steve Schramm 1 p.