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Oregon Nurse Online Article [Implementing Health Care Reform] [08/01/15]

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Implementing Health Care Reform: An Update on Oregon’s CCOs and Health Insurance Exchange

As the largest segment of Oregon’s health care workforce, nurses are fully invested in health care reform efforts. ONA is committed to ensuring that Coordinated Care Organizations (CCOs) and Oregon’s Health Insurance Exchange (Cover Oregon) improve access to quality care, that nurses and nurse practitioners are included in vital discussions about the future of the system, and that nurses are positioned as valued providers within the reformed system.

With ongoing health care reform efforts in mind, ONA’s Cabinet on Health Policy, which sets ONA’s legislative agenda, developed a limited list of priorities for the 2013 legislative session, anticipating the implementation of the previous session’s landmark health care reform legislation would continue to require extensive time and effort on the part of ONA’s staff and members.

Since the legislature last met, Oregon’s CCOs have been working hard to enroll Oregonians, begin coordinating care, and utilize the global budgeting process. Although many CCOs are operating throughout the state, they are still in their infancy and working to transition patients as smoothly as possible. Many questions about how CCOs will operate and meet the significant savings goals Oregon and the federal government agreed to still remain unanswered.

This session, ONA supported a number of bills that aimed to increase CCO accountability and transparency. All of these bills were extremely controversial. The legislature continued to express a desire to give CCOs flexibility and limit the number of state regulations and mandates that apply to them. Additional mandates, many legislators claimed, ran counter to the global budget concept embedded in the core of CCOs and may stifle innovation.

ONA supported Senate Bill 412 and similar pieces of legislation, which would have required CCOs to abide by public meeting laws in an attempt to bring accountability and transparency to the CCO decision-making process. Subjecting CCOs to public meeting regulations would allow stakeholders who may not be included in their local CCO’s governing structure, including nurses and nurse practitioners in many cases, an avenue to voice their feedback, concerns and ideas. This legislative effort was not successful this session, however, ONA is committed to continue to pursue local and statewide policies that will ensure CCOs are operating with transparency.

As with many other components of the Affordable Care Act implementation, Oregon leads the country in the creation of an insurance exchange marketplace. The insurance marketplace, or exchange, is aimed at improving the health of all Oregonians by providing health insurance coverage options, increasing access to health insurance information, and fostering quality and value in the health care system.

Oregon’s exchange, Cover Oregon, is scheduled to be up and running this October. Cover Oregon will provide a website that will more easily allow consumers to search for health care coverage by location, price, provider, quality ratings, and help identify any programs, subsidies, or tax credits they may qualify for. As part of Cover Oregon’s launch, they have recently released an ad campaign. The ads are intended to ensure the public knows that Oregon’s insurance exchange will soon be an option for purchasing health insurance, but they have gotten a great deal of media coverage for the unique and catchy approach Cover Oregon has taken.

A variety of insurers have opted to participate in Oregon’s insurance marketplace, making over 110 plans available. Over time, plans that fail to meet Cover Oregon’s established standard will be excluded from the marketplace. This session, the legislature passed House Bill 2118, which created a health plan quality metrics group. The members of this group will be appointed by the governor and asked to make recommendations on appropriate health outcomes and quality metrics to be used by the Oregon Health Insurance Exchange, which will help Cover Oregon determine which carriers to continue to include and help consumers make accurate comparisons between various plans. ONA supported HB 2118.

While Oregon is well on the way to reforming our health care system into a patient-centered, more cost-effective system through CCOs and Cover Oregon, there will continue to be bumps along the way with so many changes taking place. ONA will continue to work with our membership, the Oregon Health Authority, and other stakeholders to ensure that Oregon’s new health care delivery system provides quality affordable care for patients and fully includes and values the work of Oregon’s nurses and advanced practice nurses.

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