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Value-Based Essential Benefit Package
 
Health insurance that pays for high-value services which produce the best health results for the money spent.
 
The Value-Based Essential Benefit Package will promote access to preventive care and other effective, high-value health services. Conversely, it will create disincentives for less effective services and services that have little impact on health. It will be tailored for use in benefit plans administered by the Oregon Health Authority (OHA), including public employee benefit plans and the Oregon Health Plan and for plans offered in the Oregon Health Insurance Exchange. The benefit package will further Oregon’s Triple Aim by:
  • Improving health outcomes without increasing overall costs
  • Improving quality by encouraging the most effective services
  • Controlling costs by discouraging less effective services
The draft benefit package was created in an open and transparent public process through meetings of the Health Services Commission, the Benefits Committee of the Oregon Health Fund Board, and the Cost Sharing Workgroup of the Oregon Health Policy Board (OHPB). In addition, the package was presented to focus groups including consumers, providers, insurance plans and employers that offer insurance. Based on this process and feedback, OHPB has directed the Office of Oregon Health Policy and Research (OHPR) to continue to develop plans for a staged implementation of the package in a way that is appropriate for each covered population.
 
This site is a central location for documents and other information relating to the continuing development of the Value-Based Essential Benefit Package.
 
Next Steps Memo to the Oregon Health Policy Board (Dec. 2010)
 

Presentations to the Oregon Health Policy Board
 
OHPR has made several presentations to the Oregon Health Policy Board on value-based benefits and work on the value-based essential benefit package (as required by House Bill 2009).
 
 

Focus Group Results
 
In the fall of 2010, OHPR used funding from the federal State Health Access Program grant to conduct focus groups with stakeholders who could be impacted by this benefit design -consumers, consumer advocates, employers, providers, hospitals and insurance companies. Overall, 141 people participated in 20 sessions across the state, in both in-person and online groups. Participants were supportive of the goals of the benefit plan, but cautioned that significant educational and outreach efforts will be needed to help everyone involved understand the implications of the new benefit design.
 

Work Leading up to Latest Efforts​
 
Benefits Committee
In 2008, the Oregon Health Fund Board (OHFB) created a Benefits Committee to recommend a benefit design that would help contain costs while improving health. The final recommendation included tiering benefits and cost-sharing using the state's Prioritized List of Health Services. This  design was used as the basis of the work done in 2010.
 
OHFB Benefits Committee Final Report (June 2008)
 
 
Cost Sharing Workgroup
In early 2010, the Oregon Health Policy Board created the Cost Sharing Workgroup to examine and recommend cost-sharing options for the essential benefit plan. The group's first meeting took place soon after the signing of the Accountable Care Act in March 2010. Staff developed presentations that explained the connections between cost-sharing and premium levels, and outlined the possible impacts of federal reform on both cost-sharing and benefits for the two meetings of the workgroup. The workgroup is suspended until more detailed guidance is received from the federal and state goverment policymakers.
 
Value-Based Services
In 2010, the Health Services Commission has identified 20 sets of health care services, known as value-based services (VBS), which can be used immediately by insurance companies and purchasers both in the private and public sectors. Value-based services are medications, tests, or treatments that are highly effective, low cost, and have lots of evidence supporting their use. The Commission recommends these services have no cost sharing (copays or coinsurance) to patients in order to encourage the use of these services, given their high level of benefit.
 
Removing barriers to these effective services and treatments should help reduce higher cost interventions (e.g., hospital admissions), leading to lower health care costs and a healthier population.
 
Related information
Health Services Commission
Summary of the Value-Based Services
Value-Based Services

Other Resources on Value-Based Insurance Option
 
The Oregon Health Leadership Council has developed a value-based benefit design that is being offered by some Oregon health insurance companies. 
 
The University of Michigan hosts the Center for Value-Based Insurance Design. This site has a great deal of background information on value-based benefits, as well as updates on different efforts going on across the country. 
 
The Center for Health Value Innovations also has information on the value-based work going on around the country. 
 

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