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Health Plan Quality Metrics Committee

In this role, OFRH will be the consumer advocate voice, to ensure the recommendations put forward in fact support health equity for all Oregon women and families through valuing the care given and impacts for population health. OFRH believes that all people should have the power and resources to make healthy decisions about their bodies, sexuality, and reproduction for themselves and their families without fear of discrimination, exclusion, or harm.

Review materials and agendas at the OHA site: Health Plan Quality Metrics Committee


Follow along with Hannah as she participates as the Consumer Advocate at the Metrics Table (PDF w/ weekly posts)

Week 1 : “Right away I knew I wasn’t at a social justice meeting. Where were the group ground rules and icebreakers?”

 

 

Week 2

“The committee got right to business. We had a full agenda and wanted to get through it all. First up, selecting the Chair and Vice Chair.

Only one person put their name in the hat for the role of Chair- Kristen Dillon. She is the Director of the Columbia Gorge CCO, and formerly the owner and physician at a primary care clinic in Hood River. It sounded like a unanimous ‘aye’ vote for her! Two people were interested in the Vice Chair; they each sent a brief bio to the group beforehand and said a few words in-person- one from Providence Health Insurance and one from the Public Employees’ Benefit Board (PEBB). As soon as we were about to take the vote, a member stopped us and said he didn’t have enough information to decide. Then another member suggested that we literally put their names in a hat and draw!

Maybe I’m sensitive to making sure my vote counts, but I jumped in with plea about how we needed to vote, how we all had the same information coming in, and people should just abstain if they couldn’t choose!  So, the group landed on conducting a write-in vote. Shaun Parkman, an evaluation specialist in the Oregon Public Health Division, SEIU Local 503 member, and PEBB Vice Chair was selected. I voted for him.

Next we opened the phone-line for public comment. Crickets. No one was there but we haven’t done much for people to comment about. I hope to hear some of your voices in the meetings to come!

And finally, we reviewed the current measurement strategies of the state health care agencies we are charged with aligning metrics for.

  • The Coordinate Care Organizations (CCOs) cover Medicaid members, about 950,000 people in Oregon. CCO’s have a few categorizes of metrics, but we’re going to look at the 17 that have been ‘incentivized’- meaning there is money attached. Another group, called the Metrics & Scoring Committee, picked these and have a robust process in place for deciding which make it to the list.
  • The Public Employees’ Benefit Board (PEBB) and Oregon Educators Benefit Board (OEBB) cover about 6% of Oregon’s population. PEBB has 15 metrics they currently use and OEBB is just picking theirs. They both have goals that already include alignment with other health programs, so that’s a bonus!
  • The Oregon Health Insurance Marketplace has 135,965 individuals enrolled in private health care plans. There are currently nine insurance carriers that offer plans- and have 42 measures in their metrics set. But these are all set by a federal agency (CMS) so we’ll see how they actually fit in to this state alignment work.

Sometimes this group gets lost in conversations about changing the world with health measurements, how scientific they are, or what affect this will have on clinics, but the facilitator always brings us back to five bullet points from SB 440 about what this work is.   On the simplest level its making sure these lists have the same metrics on them. On the most complicated, it’s about moving the health care systems forward to put people and their health at the center of payment models.

And I couldn’t help but wonder, can this even be done without single-payer while in a capitalist health care system?

Until then-

Hannah 

 

First caller gets a shout out in the next blog!

June 8th 1:50pm Public Comment time: 1-877-336-1828  public line code 9657836

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