How OR Plans to Use a Public Option to Advance Health Equity

As Oregon establishes a public option in order to address health equity, it could merge this work with its efforts to unify health equity goals across health insurance markets and the state, a Manatt Health report  explained.

“Oregon will have established a health system that creates health equity when all people can reach their full health potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances,” the state has determined, as expressed in a slide deck from the Oregon Health Authority (OHA) Office of Equity and Inclusion.

In order to achieve that goal by 2030, the state is implementing a public option model.

A key facet of the implementation process is promoting alignment across all markets. Manatt Health recommended that the state take three steps to address this.

Oregon may extend the Medicaid coordinated care model’s health equity requirements to other markets, including the Affordable Care Act marketplace. This model mirrors coordinated care organizations’ approaches to care, as opposed to using insurers’ features or allowing the state to run the model through a third-party administrator.

Oregon chose to base its public option model off of the coordinated care model available in the state’s Medicaid program. But the decision to rely on that model does not have to stop with public option, the researchers noted.

Under the Medicaid coordinated care model, coordinated care organizations must produce evidence of their plans for advancing health equity, including their plans to leverage partnerships in order to address social determinants of health. 

The state provides a means for coordinated care organizations to fund efforts related to social determinants of health and health equity.

Oregon’s public option will take a similar approach, but the researchers urged the state to assert these goals across the rest of the industry as well.

Second, the researchers recommended that Oregon align its quality metrics and access to care measures across markets. 

In this area, the state would not be starting from scratch. Oregon already has an approach for aligning standards, with an aligned quality measurement set that addresses six areas from patient outcomes to cost and efficiency of care.

However, while the state has already taken steps in this direction, it can take this approach even farther, according to Manatt Health researchers. As Oregon develops health equity measures for its public option—and for other programs—these measures could be applied across all marketplaces in order to speed up health equity advancements.

Lastly, when the state rolls out its public option plan it must coincide with strong outreach efforts so that underserved populations have equal access to coverage and care. The researchers suggested that Oregon focus on sharing about opportunities for subsidized coverage that may be newly available to certain populations through the public option.

The public option program could connect with dis-enrolled Medicaid beneficiaries in order to point them toward alternative coverage, such as through the public option, or to assist with re-enrollment.

In addition to these three steps that the state can take to advance health equity across different lines of business, the researchers highlighted the need to expand value-based care and payment models industry-wide in the state. While Oregon has precedent for this, the state has room to further expand the model across all lines of business.

Oregon is one out of a couple of different states to consider instituting a value-based care model in the next couple of years. Nevada and Colorado have also been slowly moving forward with their models.

Public option has been set up against other models such as the capped provider payment.