Latest / The Health Care for All Podcast / EP7: Deep Dive into the Draft Universal Health Plan || Part 3: Who's In Charge?
Transcript
- Rebecca Schoon: this universal health plan is not trying to change the entire health system. Doctors, hospitals, they're still gonna operate the way they do now. They're mostly privately managed and owned and that won't change. What this is really changing is A, the benefits you'd all receive and B, how that care is being paid for. What is the billing process? Collin Stackhouse: How will new public... that is basically going to act as an insurance company, but it's not an insurance company how is it going to work? I want to read the description that they've shared on the bottom of page 13 about the governance and the structure. Under the board's current framework, a universal health plan would be administered by a legislatively created public corporation. A public corporation is an entity that is created by the state to carry out public missions and services. SAIF, Oregon's Workers' Compensation and Insurance Company, is an example of a public corporation. Rebecca Schoon: So public corporations are set up to really benefit the public. I know the word corporation very rightly has maybe a negative connotation, but this is not a for-profit corporation. for example, One of the benefits is that a lot of people might point to government agencies and see them as these really bureaucratic kind of dinosaur like entities that move slowly. This public corporation would have a lot more flexibility compared to say a state agency. So the governance board is really thinking about how to build a system that can flex, be responsive to the community's needs, but also have a centralized structure. that allows for efficiencies, cost savings, things like that. Collin Stackhouse: The public corporation framework that is in the proposal describes a board of directors appointed by the governor and confirmed by the Oregon State Senate, which is how the current board got selected. this board would have the authority to both set policy and also manage the operations of this new public corporation. Rebecca Schoon: All right, so we've got this public corporation. Now, as we've often talked about, this universal health plan is not trying to change the entire health system. Doctors, hospitals, they're still gonna operate the way they do now. They're mostly privately managed and owned and that won't change. What this is really changing is A, the benefits you'd all receive and B, how that care is being paid for. What is the billing process? the last part of the report we'll cover is going into those details. let's look at how providers, your doctors, how they'll be paid. Collin Stackhouse: So doctors, clinics, everybody's going to be paid directly by this universal health plan using a standardized fee schedule. significantly reducing the administrative burden on clinics and hospitals. Rebecca Schoon: This is a key point. a lot of people may not realize that, Medicaid, Medicare, every single different private insurance companies ⁓ all have different amounts of payment for that same service. That's what contributes a lot to that administrative bloat the paperwork is the number one driver of high healthcare costs in our country. So under this system, There'll be a negotiated list of prices that are standardized across the whole state. And how do you come up with these numbers? Well, typically this public corporation will negotiate with different provider groups. So it's not that the government is just in and projecting its opinion on everyone. It is a dialogue and physicians, get a say in that process. Now, if there any doctors out there listening, we're going to get into some policy wonk language. So for primary care doctors, there'll be a mix of what we call population-based payments. So this is more capitation model where you get one lump sum based on your number of patients but most of it would also be fee for service payments. So every service you provide, you get paid for that service. Collin Stackhouse: Health Care for All Oregon submitted a group testimony specifically regarding value-based payments and our recommendation was to move basically entirely away from value-based payments and towards fee-for-service. Overall, we're seeing that the direction of the governance board is to recommend more fee-for-service with a few value-based payment models that have better evidence of improving quality and reducing costs. also needs to be strategies to protect the payments for some of the highly specialized services so that these potential payment reductions in this new system do not cause outmigration of those specialties. Rebecca Schoon: So what we're talking about there is a concern that if we are using this standardized fee schedule, we might see some doctor incomes go down. we'll see some doctor salaries go up as well. But what we're talking about for specialty providers, We don't want to risk payments going down so much that these specialty providers have an incentive to leave Oregon. So that's come up also on social media. Again, the governance board has built this very careful proposal to minimize that possibility. Collin Stackhouse: Okay, so this is a phrase that I think I said earlier, but I don't really know what it means. What is a global budget and why Rebecca Schoon: you Collin Stackhouse: is it actually sort of like the cornerstone of a lot of this discussion? Rebecca Schoon: So I just mentioned capitation a second ago and I described it as, when you get one lump sum based on the number of patients you see. So a global budget is that for a hospital. So what this means is that hospital might report their expenses from the previous year, how many patients they saw, what kinds of procedures. And then we use that data to determine a global budget. a lump sum that is then given to the hospital, that hospital then gets ownership over how they choose to allocate that budget. So this is one of the most effective ways for health systems to control costs. Collin Stackhouse: I've been hearing that the idea of a global budget will give clinics, hospitals more control over their operations and some predictability in their financing. Rebecca Schoon: Absolutely. And this is so important, especially for rural hospitals. I feel like every two weeks, I look at my newsfeed and there's another report of rural hospitals closing. So global budgets stabilize those funding sources. And like you said, they know the money they have. they know what their budget is, and they can allocate that with foresight and efficiency. Collin Stackhouse: we already talked about benefits, which is that everyone in Oregon will have the same level of benefits with folks having an option to purchase supplemental insurance. If you want additional insurance, you can purchase that on your own. Rebecca Schoon: And lot of people have asked about the role of private insurance in this new system. So they would have a space to offer insurance. So they couldn't compete with the public plan, but they can offer extras, supplemental coverage. Collin Stackhouse: So sounds good, same baseline system for everybody in the state, but people in Eastern Oregon, people in Southern Oregon, people in the Willamette Valley, we all have different needs. And honestly, our communities ⁓ are different, right? Rebecca Schoon: Yeah, so one other piece that I know both of us are big fans of is the creation of regional advisory councils. ⁓ as Collin mentioned, he's on the community engagement subcommittee. ⁓ My doctoral research centered around how to engage people in health policy making within universal healthcare systems, community voice, community input, participation is critical. I love that the governance board has already built an infrastructure for this. So basically they'd be creating seven regions that have certain commonalities around health needs. these regional councils would be talking to their communities, gathering input, educating providers, a whole host Collin Stackhouse: and Rebecca Schoon: of other things. the idea here is that it's not just a big statewide agency that is projecting its way onto the whole state. There's real opportunity for local engagement and participation. Collin Stackhouse: And ⁓ these ⁓ regional advisory councils would not constitute networks, right? And that's the thing that family members and friends of mine have ⁓ expressed concerns about, right? If you want to see somebody in one county, but you're on Oregon health plan, you're not allowed to see ⁓ the provider you prefer in a slightly different county, that would not factor in to this new statewide system. But the regional advisory councils can take the concerns of the people in your area and incorporate them towards this new universal health plan system. ⁓ a final thing worth mentioning is where the pot of money is going to live, right? So there's the dedicated financing specifically towards this universal health plan, but that funding needs to go somewhere. And so the somewhere is this trust fund created within the state of Oregon, within the state treasury, separate and distinct from the general fund. it provides more flexibility and administrative efficiency once this plan is rolled out. Rebecca Schoon: So what's the big takeaway? The governance board has been doing a lot of work. And so this is the first glimpse that the public is getting of the results of that work. It has a lot of details down. There's still more details to figure out though. So to end this with the idea that we started with. This is a draft. These are their initial recommendations, but they released it in April so that we have until the December deadline for Oregonians to give your input. What did you like? What do you have questions on? What would you like more details on? What do you want them to change? Now's the time for you to let them know. Collin Stackhouse: I think it's a little goofy to say this, but it is accurate that in this podcast, we have given you a summary of a summary, right? And honestly, a partial summary of a partial summary of all the work that's been done. All of the work that went into creating this document that we just walked you through is available for the public to view. that's available at oregon.gov slash UHPGB. So we encourage you to take a peek there. Rebecca and I did a shorter version of this episode which goes over the final few pages of this document. Rebecca Schoon: So is that a summary of a summary of a summary? Collin Stackhouse: Yeah, yeah, We call that the triple sum in the biz. So just now we walked through pages one through 14 of this 18 page document. Our other episode is simpler. and that goes through pages 15 through 18 of the plan summary. So we encourage you to listen to that synopsis episode. I want to talk about the opportunities that Oregonians have right now to engage with the governance board, to talk with them about thoughts that are coming up by hearing the summary or suggestions that you think haven't been considered in their work. The first is the main universal health plan governance board meeting, which happens both in person in Salem and also remotely that's Pacific time. 9 o'clock in the morning till 1230 p.m. and that's on the third Thursdays. The Community Engagement and Communications Committee is the committee that I'm on and we meet on the fourth Wednesdays of the month with an hour dedicated from 5 to 6 specifically to listen to public comments from Oregonians like you. In the general meetings you only have about one to two minutes to speak but in our community engagement meetings You have five minutes to speak directly to members of the governance board and other committee members about what you need in a new system. The meetings of the Community Engagement and Communications Committee, where you have a dedicated hour to speak directly to the Governance Board, are from 5 to 6 p.m., And all of those meetings are on Zoom. Rebecca Schoon: So those are a lot of opportunities to get your voice heard. what HCAO is hoping to help you with to break down all this confusing information so that you can understand what's being proposed and again, raise your voice around it. Now let us know whether on social media or on our website, let us know what you want to hear more about. We can do special episodes that deep dive into any part of this plan or other so let us know what you want to hear. Collin Stackhouse: Totally, thanks for sticking with us. we'll see you next time. Rebecca Schoon: See you next time, bye.