lessons learned from health care reform
DESCRIPTION
Lessons Learned from Health Care Reform. Presentation to Citizens’ Health Care Working Group September 23, 2005 Jean Thorne, Administrator Oregon Public Employees’ Benefit Board (PEBB). Background. State Medicaid Director 1987-1995 Director, Department of Human Services 2003-2004 - PowerPoint PPT PresentationTRANSCRIPT
Lessons Learned fromHealth Care Reform
Presentation to Citizens’ Health Care Working Group
September 23, 2005
Jean Thorne, AdministratorOregon Public Employees’ Benefit Board (PEBB)
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Background
State Medicaid Director 1987-1995
Director, Department of Human Services 2003-2004
Administrator, PEBB 2004-Present
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Pre-Oregon Health Plan
1987 Coverage for transplants discontinued Coverage for pregnant women and
children expanded Discussion of trade-offs begins
1988 Growing public awareness of need for
health care reform
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Pursuing Federal Waivers for OHP
Criticism from national advocacy groups
National press focus on health care “rationing”
Importance of a united front Discussion of trade-offs National reaction when waiver
denied
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Implementing the OHP
Changes occurring Benefits based on prioritized list Managed care delivery system Expansion of eligibility to FPL
Approach Start-up would not be delayed Constant communications We’re all in this together
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OHP Start-Up (under a national spotlight)
Cries for coverage No “big stories” Change in press focus Working through the kinks Involvement of advocates Being part of positive change
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Use of the Prioritized List
Tool to force explicit policy decisions Allowed policy makers to reduce
services in rational manner Unwillingness of federal government
to accept Impact on ability to sustain program
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Purchaser Role in Moving Change
PEBB Vision for 2007 Systems of care Outcomes Evidence-based medicine Transparency
Need for provider ownership Collaborative efforts in a
competitive market? Challenges in engaging members
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Lessons Learned We’re all part of the problem – and
the solution No magic bullets – trade-offs are
necessary Need for provider ownership to
achieve change Importance of credible political
leadership Stakeholder groups can help Media can be a partner
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Challenges
Limitations of a competitive model Need for all providers to focus on
greater good Limitations of a consumer-based
approach Limitations of a purchaser-based
approach Gaining public understanding of a
complex issue