In an effort to provide
additional and improved health care options for state employees who live
outside the greater Salem area — and those living in rural Oregon in
particular — the PEBB Board of Directors has voted to delay one year a
Request for Proposal (RFP) for it's health care program.
AFSCME supported the
one-year delay. Diane Lovell, Council 75's representative on the PEBB Board,
says the goal is to provide the most members it can with the greatest number of
and best possible options.
"To oversimplify it a bit,
people around the state would like an option equivalent to the Providence
Choice plan design," says Lovell. "But Providence Choice and/or its equivalent
aren't available everywhere because there is not sufficient demand among
purchasers. Providence has done a good job expanding their Choice program every
year, but we haven't been able to make progress with providers in Eastern
Oregon and other rural areas. By waiting, we can work to negotiate and
encourage other providers to participate, creating more demand."
Lovell explains that the
"Providence Choice" designation is actually available to any provider(s) who
meets the standards of Providence Choice. The barrier is that most providers
don't want to meet that higher standard of adherence to evidence-based
standards and care coordination. In recognition of that challenge, PEBB
has developed an additional pathway for providers to be certified, but that
will take some time and encouragement.
Lovell recently toured
Eastern Oregon during PEBB's Open Enrollment meetings and heard AFSCME members
express concern about the lack of in-network providers and lack of access to
the Providence Choice plan design. She and the rest of the PEBB Board are
convinced delaying the RFP for 12 months is the best way to garner greater
participation from providers.
"People are surprised to
find out that even though the State of Oregon is a very large employer, other
than in Marion County, PEBB does not include a sufficient number of
concentrated enrollees to drive the required change in the delivery system,"
said Lovell. "Not only is this true for places like Pendleton, Umatilla and
Ontario, it's even true for greater Portland. Therefore, we believe that this
one-year delay is our best strategy for expanding the opportunity for
well-coordinated, patient-focused health care for our members throughout the
Lovell says PEBB will spend
the next year collaborating with both private and public health care purchasers
in various regions of the state, both urban and rural. PEBB will share its
approach to improving the health care delivery system while learning best
practices from other employers.
"The goal is to create a
larger, more consistent approach to purchasing evidence-based,
well-coordinated, health-focused care by many employers in a region," she said.
"While no one is happy about the delay piece of the puzzle, again, we want to
get the most options possible for the most people, and this is the way to do
The change means that PEBB
will spend 2013 meeting with purchasers throughout the state, attempting to
build consensus on a health care purchasing strategy. Subsequent changes would
begin in 2015.