Member Spotlights
Oregon Department of Human Services, Office of Reproductive Health
By Liz Rich
The Oregon Health Authority manages the Oregon Reproductive Health Program, which serves more than 75,000 men, women, and teens across the state in a variety of settings, including county health departments, Planned Parenthood health centers, federally qualified health centers, school-based health centers, and universities. It is one of two Title X grantees in the state and receives both federal and state funding to administer the state’s Medicaid family planning waiver. The program, housed under the state’s Public Health Division, is administered by a cross-discipline staff, including health care professionals as well as staff focused on program integrity, data systems, policy, and legislative analysis.
In 2014, Oregon took an unprecedented step to rein in health care spending by transferring its entire Medicaid program into regional coordinated care organizations (CCOs) that use a network of health care providers from different practices that work together at the local level to serve its patients. With this new approach, CCOs are required to reach certain quality metrics, such as lower hospitalization rates and decreased primary care spending. This move created a prime contracting opportunity for the state’s family planning provider network.
The Oregon Reproductive Health Program has been instrumental in defining a new quality measure on contraceptive use and developing guidance to accompany it. The measure, “effective contraceptive use among women at risk of unintended pregnancy,” is one of the many quality metrics the state uses to award funds to CCOs. The metric’s emphasis on effective contraceptive use is a priority for the Reproductive Health Program because it gives Medicaid providers within their network enough leverage to contract with CCOs. The Reproductive Health Program has also worked with the Oregon Preventive Reproductive Health Advisory Council to develop standards for the provision of contraception and preconception care for primary care and family planning providers, which rely heavily on Quality Family Planning Recommendations (QFP) , a report developed collaboratively by the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA), and are intended to ensure broad access to high-quality family planning services provided across diverse health care settings.
In addition to helping develop these new quality metrics for the CCOs, the Reproductive Health Program staff has been working with colleagues in the Adolescent and School Health Program to lead a policy workgroup within the Oregon Health Authority on patient confidentiality. The work has focused in part on inadvertent breaches in patient confidentiality related to insurance billing communications, and they have developed a relationship with the Oregon Insurance division to understand the policy landscape, specifically health insurance carrier policies and practices related to claims communications and patient confidentiality. In addition to developing this partnership, the Reproductive Health Program has also created and distributed a survey to providers in order to gain a better understanding of how patient confidentiality concerns impact provider practice, as well as policies and practices used to strengthen confidentiality protections. The results showed that concern about confidentiality is impacting care in that it affects providers’ ability to bill for services and also affects how providers treat their patients. Respondents also indicated an interest in additional education and training related to provision of confidential services, including information about the policies of health plans with which they contract.
In the future, the Reproductive Health Program plans on surveying Coordinated Care Organizations about their practices and policies around member billing communications. Mirroring Title X’s requirements for confidentiality, the Reproductive Health Program has maintained client confidentiality for the state’s Medicaid family planning waiver, known as ContraceptiveCare, by allowing all enrollees, regardless of age, to request special confidentiality. Special confidentiality means providers can directly bill ContraceptiveCare, which has been requested by approximately 13% of patients and a higher percentage of ContraceptiveCare enrollees with private insurance, according to recent enrollment data.
Additionally, a bill was recently signed into law in Oregon allowing patients to request their health insurer send communications directly to the member receiving benefits, rather than to the primary policyholder. The efforts to pass HB 2758 were led by Planned Parenthood Advocates of Oregon; the Oregon Health Authority as a state agency was unable to formally support or oppose any bill not sponsored by the governor. The agency was able to provide legislative analysis from a public health perspective that was available to legislators considering the bill. In addition, the foundational work the agency has been doing around convening stakeholders proved useful when advocates and insurance plans worked together on amendments. Following passage, the agency is working with the Insurance Division on roll-out and rules development. The Reproductive Health Program hopes that effective promotion of the law by both providers and consumers will help individuals become more aware of their right to request confidential communications.