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January 2009

Oregon Releases Plan for Creating a World-Class Health Care System

In November 2008, the Oregon Health Fund Board released Aim High: Building a Healthy Oregon, a comprehensive blueprint for reforming Oregon’s health care system.  The Oregon Health Fund Board, created by the Healthy Oregon Act of June 2007, is a group of seven individuals supported by more than 150 Oregon volunteers, who were tasked with reviewing research and expert testimony and studying successful models in other states and countries. The Aim High blueprint was 14 months in the making and is the result of the most extensive analysis of health care in Oregon in 20 years—including the collection of testimony from 1,500 Oregonians who submitted comments during statewide town hall meetings. [1] 

The blueprint’s central message is that Oregon’s health system is broken and that the pragmatic choice—not the idealist goal—is to transform the system by aspiring to a new vision of world-class health and health care in Oregon. The overarching conclusion of the Board is that the Oregon health system should achieve three objectives: a healthy population, extraordinary patient care for all, and reasonable per capita costs shared in an equitable way by the entire population.[2]

One of the central recommendations for the 2009 legislative session is to create an Oregon Health Authority to be a catalyst for change by becoming the organizer and integrator of Oregon health care policy and purchasing, and the coordinator of the State’s investments in health service innovation.  The Authority is to focus on quality, costs, and the health of the population by using seven strategic building blocks for change:

  • Improve access for children and low-income adults—Provide health insurance to all children in Oregon within the current delivery system by: increasing public program eligibility levels from 185 to 200 percent of Federal Poverty Level (FPL) with no cost-sharing requirements; through sliding scale premium assistance to those children in families with access to employer-sponsored insurance (ESI); and, for children with no access to ESI, the creation of a new program with sliding scale premiums for those between 200-300 percent FPL and a full-cost buy-in for those with higher incomes.  Also, additional low-income adults will be permitted to join a reopened Oregon Health Plan (enrollment is currently capped) which provides health coverage to low-income Oregonians. These expansions will be financed using a restructured provider tax mechanism and possibly other revenue sources that can leverage federal matching funds. Future phases of coverage expansion to approach near-universal coverage include a requirement that all residents obtain health insurance coverage, reforms to the non-group market, a “pay or play” employer payroll tax, and the development of an insurance exchange/connector.
  • Cost containment and quality improvement mechanisms—Improve the quality of care that Oregonians receive and decrease costs using various policy levers including: the establishment of an all-payer/all-claims data collection system; development of a common set of measures and targets for quality improvement; increased use of evidence-based practice; establishment of an Oregon Quality Institute; and simplification and standardization of administrative processes to decrease administrative costs.
  • Purchasing strategies and insurance market reforms—Coordinate and align the State’s purchasing policies across public entities; create a health insurance exchange (connector) to consolidate the non-group market; consider developing a publicly-owned health plan option; and, use regulatory powers to monitor and control increases in health insurer administrative expenses as well as provider charges.
  • Encourage new models of care delivery—Employ strategies including developing integrated health homes (sometimes called medical homes) and accountable health communities to support them; integrating behavioral health with physical health; preventing health disparities through the use of culturally-specific approaches to promote health and preventing chronic conditions; restructuring payment systems to encourage better organization of the delivery system; providing appropriate end-of-life care; linking population health and public health strategies to the health care delivery system; and encouraging the development of interoperable health information technology and exchange.
  • Ensure health equity for all—Focus strategies to address the social determinants of health through health promotion, chronic disease prevention, reduced barriers to health care, and improved quality of care.
  • Train new health care workers—Develop a strategy to improve the training, recruitment, and retention of all levels of health care providers including assuring they are provided the appropriate education to increase cultural competence.
  • Federal-state relationship—Advocate for federal changes such as federal waivers, additional funding and numerous other policy changes that support the health care goals of Oregon.

The Board believes that access to health and health care for all Oregon residents is possible within a decade if the state builds the infrastructure needed to deliver health care with higher quality and at lower cost.  The report details a strategy for providing universal access that includes building on the present insurance model while also developing a publicly financed insurance plan to fit within the individual market exchange.  Currently, about one in six Oregonians is without health insurance coverage.

The blueprint stresses that investment in community clinics and public health initiatives is also crucial for providing health services at the right point in time and for creating a healthier population.[3]

[1]Oregon Takes a Major Step Toward Affordable Quality Health Care,” Oregon Health Fund Board, press release, November 25, 2008.

[2]Aim High: Building a Healthy Oregon, Oregon Health Fund Board, November 25, 2008.

[3] Ibid.