A Foundational Element
i Oregon
in
O
Health
H lth Reform
R f
Sean Kolmer
Deputy Administrator
Office for Oregon Health Policy &
Research
1
What is the Office for Oregon Health Policy
& Research (OHPR)?
Administrator appointed b
by Go
Governor
ernor and
Senate confirmed
 Oregon
O
Health
H lth A
Authority
th it
 Staff to Governor appointed bodies





Oregon Health Policy Board
Health Resources Commission
H lth S
Health
Services
i
C
Commission
i i
Medicaid Advisory Committee
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What does OHPR do?

Responsible
R
ibl ffor th
the d
development
l
t and
d analysis
l i off
health policy in Oregon


Reports and conducts analyses relating to health care
costs, utilization, quality, and access
Provides analysis,
analysis technical
technical, and policy support
to the Governor, the Legislature and the Oregon
Health
ea t Policy
o cy Board
oa d

Effective partnerships with health services
researchers to inform policy
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We don’t
don t know,
know what we don’t
don t know




Oregonians pay for health care without comparable
information about cost and quality across the health
care system settings.
F
From
a variety
i t off sources, estimates
ti t for
f Oregon
O
health care spending range from $20-25 billion or
,
and $7,000
,
dollars per
p Oregonian.
g
between $5,400
Currently, Oregon has fragmented, inconsistent and
incomplete information about how our health care
system is performing
An all payer, all claims data database is a tool for
better understanding of cost, quality, and utilization
across Oregon’s
O
’ h
health
l h care system.
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4
Major reform legislation in 2009
 HB

2116
Coverage expansions
p
 HB
2009
Creates
the Oregon Health Authority,
Authorit
overseen by the Oregon Health Policy Board
Sets
S system reform
f
in
i motion
i through
h
h key
k
cost containment and quality measures

Establishes an all-payer, all-claims reporting program
5
6
O
Oregon’s
’ all-payer,
ll
all-claims
ll l i program vision
ii

I is
It
i not about
b
collection
ll i

Foundational element to health reform efforts
 Development,

implementation and evaluation
Accountability of public dollars
 State
St t
is
i major
j purchaser
h
off health
h lth care
 Over 1 in 4 Oregon lives
 Over 1 in 3 under 65 Oregon lives

Resource for action by state and others (i.e.
communities,, industry)
y)
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Legislative
g
framework

Who
 Commercial
health insurers, third party
administrators, managed care organizations,
pharmacy benefit managers, Medicaid fee-for-service
 Intent
I t t to
t acquire
i Medicare
M di
claims
l i

What
 Medical,
dental, pharmacy claims
 Eligibility files
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What can the system be used for?









Determining the maximum capacity and distribution of existing
resources allocated to health care.
Identifying the demands for health care.
Allowing
g health care p
policymakers
y
to make informed choices.
Evaluating the effectiveness of intervention programs in improving
health outcomes.
Comparing the costs and effectiveness of various treatment
settings
tti
and
d approaches.
h
Providing information to consumers and purchasers of healthcare.
Improving the quality and affordability of health care and health care
coverage.
coverage
Assisting the administrator in furthering the health policies expressed by
the Legislative Assembly in ORS 442.025.
Evaluating health disparities
disparities, including but not limited to
disparities related to race and ethnicity.
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Implementation
p
progress
p g

Final administrative rules March 1, 2010
 Stakeholder
advisory
y committee meetingg from
November-February
 Covers services delivered starting January 1, 2010


Data collection/analytic vendor RFP to be
released soon
Operational program Fall 2010
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Opportunity
Oppo
tu ty for
o co
collaboration
abo at o


Our history working closely with health services
researchers is a tremendous asset we will continue
to leverage and seek out
M
Many
possible
ibl partnerships
t
hi with
ith stakeholders
t k h ld
with
ith
shared vision for change
 CMS
and other federal partners (i.e. medical home
pilots, Medicare data sharing agreements)
 Other states
 Health
H lth services
i
researchers
h
 Local communities
 Public health
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Contact Information
Sean Kolmer, MPH
p y Administrator
Deputy
Office for Oregon Health Policy & Research
Oregon Health Authority
503 373 1824
503-373-1824
Sean.Kolmer@state.or.us
http://ohpr.oregon.gov
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