Bridging the Gap. The Oregon Health Plan.

We’ve all heard about proposed policies from Medicare for All to Universal Basic Income that aim to reduce income disparities and the effects of having a low income. While these policies have garnered support nationally, they have not yet been codified into law. The Oregon Health Plan (OHP) represents one such bill designed to support the healthcare of all Oregon inhabitants that was proposed and enacted by the state legislature.

Why was the Oregon Health Plan enacted? 

The Oregon Legislature passed a series of bills from 1989 to 1993, providing benefits to Oregon residents and increasing Medicaid coverage. (1) The plan itself was activated early in 1994. But why was the OHP created in the first place? First, in the late 1980s and early 1990s, Oregon’s uninsured population was rising, resulting in many individuals lacking proper access to healthcare services. Furthermore, during the 1990s, the federal government was looking to improve healthcare access with debates being held about how to reform the status quo system. These two factors put pressure on Oregon legislators to expand access and improve healthcare coverage.

What does the OHP include?

1. The first part of the OHP expanded Medicaid increasing healthcare coverage to low-income Oregon families. Medicaid is a government service providing healthcare access to low-income families across all 50 states. Oregon was previously a Medicaid expansion state, meaning that the state legislature had expanded who qualifies for Medicaid healthcare coverage beyond what is required by federal law. Under Senate Bill 27 (passed 1989), Medicaid eligibility was expanded even further, to individuals up to the poverty level.

   Below is a map of Medicaid expansion across all 50 states in 2023. While some states have not expanded Medicaid programs yet, Oregon was one of the first; furthermore, Oregon has expanded Medicaid to individuals living at the poverty line, providing far greater access compared to most other expansion states.

2. Perhaps most importantly, the Oregon Health Plan established a coordinated care network. This network is made of several coordinated care organizations (CCOs) led by the Oregon Health Transformation Center. (3) Each CCO is responsible for providing care to local individuals, coordinating with community organizations and building health screening programs. This coordinated care network provides holistic care to OHP members, improving health outcomes by providing mental, dental, and physical care and by addressing social determinants of health. Prior to the OHP, mental, dental, and physical care were administered via different systems. Patients and healthcare providers were forced to navigate between these different systems, resulting in delays in receiving care and increased costs.

Below is a map of Oregon and the various Coordinated Care Organizations that serve as part of the OHP. The regions each CCO provides for are also documented. (4)

CCOs have fixed budgets that must be allocated for different types of care. Each CCO is responsible for the health of the individuals in their community with the goals of better care, better health, and lower costs. The Oregon Health Transformation Center controls the coordinated care network by using data to create quality improvement initiatives that are then directed by each CCO. (5) The Transformation Center is designed to train CCOs, bring stakeholders into the decision-making process, and improve preventative health with interventions including cancer screenings and immunization clinics. The Transformation Center designs health-advancement initiatives including community health assessments, improvement and spending plans, performance improvement projects, and advisory council demographic reports, among others.

3. The OHP also shifted the state’s health focus from primary and inpatient care to preventative care. (6) Not only does preventative care mean catching disease early resulting in better outcomes but preventative medicine also reduces disease progression, saving patients’ money. The OHP covers a variety of preventative services including the following: (7)

• Nutrition, Alcohol-Use, and Depression counseling

• Flu and pneumonia shots

• Baby and child visits from ages 0-21

• Pregnancy and breastfeeding counseling

• Routine measles, polio, and meningitis vaccines (among others)

• Cancer screenings (mammograms and colonoscopies)

• Blood pressure, cholesterol, and diabetes tests

4. The last effect brought about by the OHP was a shift from fee-for-service reimbursement to a value-based-payment model. In a fee-for-service system, the service an organization provides determines the fee they are paid; on the other hand, in a value-based system, the quality of care provided and the patients’ final outcome are factored into the cost. (8) While a fee-for-service system incentivizes providers to complete as many interventions as possible and with little regard for the outcome, a value-based model puts the patient first.

   The Oregon Health Authority declared that the fee-for-service system in the state should be phased out for 4 reasons. (9) First, the value-based model provides a consistent revenue stream for rural providers by focusing on the quality of care over quantity. Second, the value-based system provides providers with a predetermined budget for treating a specific illness. Third, the value-based system addresses non-medical factors that affect care, allowing providers to identify social determinants of health that may affect care, and treat the patient more holistically. Finally, the value-based system enables providers to be more flexible, putting the patient first and prioritizing patient care over hospital turnover.

The Oregon Health Plan (OHP) has played a pivotal role in expanding healthcare access and improving outcomes for Oregon inhabitants. Moving forward, the OHP has sparked new conversations about improving healthcare outcomes at the legislative level and how to use holistic and preventative medicine to solve chronic problems. As we consider new policies and proposals designed to increase access to care (such as Medicare for All), we should look back to the OHP and other similar successful plans, prioritizing the patient’s outcome and adjusting goals when community needs evolve.