The commercial market in Oregon and Washington is seeing an increase in cost sharing with high-deductible plans and higher premiums. Employers are trying to control rising costs by implementing innovative plan designs that improve employee wellness and encourage members to make smart healthcare decisions.
Medicare Advantage private-fee-for-service plans have exited most of the Oregon and Washington market. Other companies are seizing opportunity where PFFS exits have forced seniors to choose new plans. The Medicare Advantage Plan star rating system will factor into plan reimursement rates in 2012. Plans are ramping up to improve star ratings by hiring additional staff and using incentives to help members make healthier choices.
The Oregon and Washington state Medicaid programs use disease management programs aimed at helping members take control of their healthcare outcomes by seeing their primary-care physicians regularly and adhering to drug therapies. Both states use vendors that are actively involved in managing the programs.
The Oregon Coalition of Healthcare Purchasers is teaming up with Pfizer to help employers design and implement value-based insurance design. Pfizer will analyze the data and make recommendations to the employer groups about their plan designs.
A recent report examines Group Health Cooperative's medical home pilot in Washingon. The report outlines benefits and challenges of patient-centered medical homes.