Oregon & Washington | Winter | 2010 | Health Plan Analysis

In an effort to curtail the growing cost of specialty drugs, Regence has developed a new benefit design with a standard and extended six-tier formulary that combines medical and prescription drug benefits. The design, called Medication Cost Integration, recognizes medication options traditionally covered under the medical benefit meaning there is potential for increased competition among drug manufacturers hoping to get their products placed on favorable tiers. Group Health Cooperative is converting its 26 Washington and Idaho clinics to patient-centered medical homes following a successful two-year pilot. The GHC model has been shown to cut emergency department visits by 29 percent and hospitalizations by 11 percent. The cost of patient care did not increase, and preliminary results suggest that the medical home may even lead to lower costs. Five healthcare plans in Oregon are now part of a first-ever health exchange for children called Healthy KidsConnect. As of Jan. 1, 2010, families with incomes between 201 percent and 300 percent of the federal poverty level can apply for state-subsidized healthcare coverage. The plan is designed to serve as many as 34,000 children with benefits similar to those offered through the Oregon Health Plan, the state's Medicaid program.