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Healthy Contracts Legislation; Measurement & Value-Based Payment Contracting: Online Screening & Outcome Measurement Software

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3 Crucial Ways to Improve House Bill 4069 to Establish the Aligning for Health Pilot Program

House Bill 4069, introduced by Representative Maxine Dexter during the 2024 Regular Session of the Oregon Legislative Assembly, proposes the establishment of the Aligning for Health Pilot Program. This initiative, administered by the Oregon Health Authority (OHA), aims to test alternative payment methods in healthcare with the overarching goal of improving health outcomes and cost containment. The legislative session ended while the bill was in committee. Representative Dexter resiged August 31, 2024. There is reason to believe the Oregon Health Authority will ask newly elected Representative Shannon Jones Isadore to reintroduce HB 4069.

Key Features of the House Bill 4069

1. Establishment and Goals

  • The program seeks to create more predictable, aligned payment models and metrics for healthcare providers.

  • It aims to increase the number of providers receiving population-based payments tied to health outcomes.

  • The program encourages innovation in care delivery and addresses complex health drivers.

  • It emphasizes equitable access to quality health services and better health outcomes.

2. Implementation Phases

  • Phase One: Planning includes hiring staff, conducting necessary analyses, and engaging stakeholders.

  • Phase Two: Finalizing risk mitigation strategies, engaging providers with technical support, and soliciting proposals from employer groups and payers.

  • Phase Three: Awarding contracts and launching the program with potential expansion based on initial outcomes.

3. Participation Requirements

  • Payers must sign onto the Value-Based Payment Compact, adhere to global budgets, and partner with community-based organizations.

  • Providers must assume accountability for patient groups, bear financial risk for spending targets, and agree to performance-based payment adjustments.

  • Purchasers can select and adjust benefit packages but must include all enrollees in the pilot region.

4. Regulatory Framework

  • The OHA will set global budgets, establish processes for rate appeals, and ensure costs are not shifted excessively to enrollees.

  • The program will include risk mitigation strategies such as the Oregon Reinsurance Program, risk corridors, and a risk stabilization fund.

  • Regulatory relief may be provided to encourage innovation but will not compromise patient or provider safety.

5. Monitoring and Evaluation

  • The OHA will monitor the program's implementation, collect and analyze data, and ensure that participation does not reduce access to care.

  • Interim assessments and formal evaluations will be conducted to measure the program’s success and recommend future expansions.

6. Health Equity Fund

  • A fund will be established to support community-based interventions targeting social determinants of health, financed collectively by multiple payers.

7. Pilot Region Advisory Groups

  • Advisory groups will be formed in each pilot region, primarily composed of representatives from communities of color, tribal communities, immigrants, refugees, and underserved areas.

8. Sunset Clause

  • The Act is set to sunset on January 2, 2035, providing a timeframe for the program's evaluation and potential institutionalization.

  • House Bill 4069 seeks to transform healthcare payment models in Oregon, promoting value-based care and equitable health outcomes through a carefully monitored and phased pilot program.

3 Crucial Ways to Improve House Bill 4069

To ensure the success of House Bill 4069 and the Aligning for Health Pilot Program, it is essential to incorporate the Healthy Contracts proposal This can be achieved by adding specific implementation requirements which promote transparency, accountability, and collaborative efforts among all stakeholders. Here is an expanded and detailed plan for integrating these principles:

3 Crucial Requirements

1. Ethics Point Portal

  • Implementation: Establish an Ethics Point Portal for each payer accessible to all participating providers allowing anonymous reporting of concerns and issues related to contracts and operations. Each portal should be overseen by an independent body to maintain impartiality and confidentiality.

2. Independent Certified Internal Auditor (CIA)

  • Implementation: Retain Independent Certified Internal Auditors responsible for monitoring, investigating, and reporting on shared measurement and value-based contracts as well as submissions to the Ethics Point Portal.

  • Implementation: CIAs will support conversations between healthplans and providers to create transparent shared values, objectives, controls, rigorous tests for design and effectiveness, residual risk analysis, and key performance measures.

    • Importance: Facilitates open dialogue and collaborative efforts among providers, fostering a culture of transparency and mutual accountability. This approach helps to identify and address issues early and improve overall program effectiveness.

      For more information see:
      What Can Certified Internal Auditors Do That Will Prevent Healthplans From “Gaming” Providers, Purchasers, and The Public?
      https://www.mentorresearch.org/gaming-a-valuebased-contract

3. Plain and Understandable Contract, Requirements and Policy Language

  • Implementation: Draft all contracts and policy documents in plain and understandable language that maps to operational procedures and expectations. Include detailed explanations to ensure all stakeholders understand their roles and responsibilities.

Role of Independent Certified Internal Auditors

Independent Certified Internal Auditors (CIA)

  • Implementation: CIAs will play crucial roles in ensuring ethical and accountable practices within the Aligning for Health Pilot Program. They will be responsible for:

    • Overseeing Ethics Point Portals and investigating reported concerns.

    • Monitoring compliance with shared measurement and value-based contracts.

    • Providing regular reports on contract performance, ethical issues, and compliance to all stakeholders.

    • Ensuring that contract terms and operational procedures are clearly understood and adhered to by all parties.

  • Importance: CIAs’ independence from Healthplans’ management is critical to maintain objectivity and prevent conflicts of interest. As they provide impartial oversight, CIAs ensure ethical standards are upheld, while they foster trust and integrity.

Conclusion

Integrating the Healthy Contracts initiative with HB 4069 is crucial to success for the Aligning for Health Pilot Program. By establishing Ethics Point Portals, employing independent CIAs, ensuring clear contract language, promoting transparent shared values, and supporting providers’ collaborations, the program can achieve its goals of improved health outcomes and cost containment. This comprehensive approach not only aligns with the objectives of HB 4069 it aligns with best practice standards for ethical and accountable healthcare contracting.

References

Independent Certified Internal Auditors

Ethics Point Portals

Shared Values, Objectives, Controls, Tests of Design and Effectiveness, and Key Performance Indicators.

Transition from Fee-For-Service to Value-Based Payment Contracts

Challenges

DISCLAIMER and PURPOSE: This discussion document is intended for training, education, and research purposes only. The information contained herein is based on the data and perspectives available at the time of writing. It is subject to revision as new information and viewpoints emerge.

For more information see: https://www.mentorresearch.org/disclaimer-and-purpose

Key words: Supervisor education, Ethics, COVID Office Air Treatment, Mental Health, Psychotherapy, Counseling, Patient Reported Outcome Measures,