Powerlist: health plans

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Articles - November/December 2013
Monday, October 28, 2013

BY BRANDON SAWYER AND LINDA BAKER

1113 Powerlist 01Don Antonucci, President, Regence BlueCross BlueShield of Oregon 

OB: How is Oregon’s rollout of the exchange, CCOs and other Affordable Care Act (ACA) provisions going?
Don Antonucci: The health care industry is going through the biggest period of change in the last 50-plus years. So there will undoubtedly be growing pains, but we’ll ultimately get through them together because at the end of the day, providing more care to more Oregonians is something we all need to get behind. Coordinated/accountable care organizations are an exciting innovation that is truly coming alive here in Oregon. For too long we’ve paid for volume of care rather than value. Regence is working with providers like Legacy, Adventist and Tuality on agreements that reward doctors for producing healthier patients by tying financial incentives to quality and cost metrics.

OB: Is the health care business different in Oregon?
DA: Oregonians seem more engaged in their health care choices than some other areas of the country. The amount of enthusiasm and attention directed toward Cover Oregon over the past few months is a perfect example. And part of this is our leadership: Gov. Kitzhaber was recently named the second most influential person in health care by ModernHealthcare.com, and he’s led innovation efforts in our industry dating back well before the ACA.

OB: Given recent politics, will the bulk of the ACA finally be implemented?
DA: The fact of the matter is that the ACA is now the law of the land. We’re moving forward and doing our part to make sure it’s implemented, and implemented well.

OB: Will the act be a success?
DA: The ACA should really be called the Accessible Care Act, because what it does is provide coverage to more people. So in terms of improving access to care, yes, I think it will be a success. Where there needs to be more focus is on addressing costs. The only way we’re going to help reduce costs and curb the wasteful spending and inefficiencies in our current system is if we all get more involved and play our part. Insurers and hospitals need to be more transparent about what care really costs; employers need to engage their employees around wellness and healthy behavior; and consumers need to take more accountability for their own health choices.


1113 Powerlist 02DR. Ralph Prows, CEO, Oregon’s Health CO-OP 

OB: Is the Health CO-OP a typical cooperative?
DR. RALPH PROWS: A cooperative is typically a company that is owned by the members. Oregon’s CO-OP stands for “consumer-operated and oriented health plan” and is a plan that was created under the Affordable Care Act. When the ACA was in discussion, a lot of people really wanted a public option, but that wasn’t going to go. That’s where the compromise came up about creating co-ops: How could you get something like a public option without having a single-payer system? Co-ops all have to be nonprofits and all have to elect a board of directors that, in its majority, is representative of the members it serves.

OB: How does the CO-OP differ from other nonprofit health care providers?
RP: In most cases, nonprofits have a specific business plan that does not require them to use their profit to lower premiums or promote health plans and benefits for their members. We are a special kind of nonprofit that is governed and run by the members, and we have to do what the members want. So we created focus groups; we talked with 2,000-plus Oregonians and took the stuff we heard to do things people wanted and not do things people didn’t want.

OB: Cover Oregon has designated the CO-OP as an “innovative plan.” Why?
RP: We are bringing on naturopaths not as complementary and alternative but as primary care providers. We’re the first health care plan in the country to do that. We also heard from people that insurance is way too complicated and they can’t figure out how much things cost. So we decided to get rid of coinsurance all together and make it a series of straight-up co-pays. There is a deductible on outpatient surgery and in-patient hospital stuff. That’s where you make up for it.

OB: Are you concerned about political opposition to the Affordable Care Act?
RP: It’s very scary. The CO-OP was actually supposed to be installed in all 50 states. At the fiscal cliff in January, it was decided funding would be rescinded. So now there are co-ops in only 23 states. It worries me because maybe we would like to expand in the future. Who knows what kind of shenanigans will occur or what kind of horse trades will happen? And could something be done to defund our loans? What I’ve learned watching this is anything might happen.



 

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