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HERC January 12, 2012 Page 1 Minutes HEALTH EVIDENCE REVIEW COMMISSION Meridian Park Hospital Health Education Center, room 117B & C Tualatin, Oregon January 12, 2012 Members Present: Gerald Ahmann, MD; Wiley Chan, MD; Alissa Craft, DO, MBA; Irene Croswell, RPh; Lisa Dodson, MD; Leda Garside, RN; Mark Gibson; Carla McKelvey, MD; Vern Saboe, DC; Som Saha, MD, MPH; James Tyack, DMD; Kathryn Weit; Beth Westbrook, PsyD. Members Absent: none Staff Present: Darren Coffman; Ariel Smits, MD, MPH; Cat Livingston, MD, MPH; Dave Lenar; Margie Fernando. Also Attending: Sean Kolmer (Governor’s office); Jeanene Smith, MD, MPH (OHPR); Linda Grimms (DOJ); Dave Fischer (AMH); Ann Neilson (Amgen); David Barba; Ellen Lowe (OAHHS); Denise Taray and Walter Shaffer (DMAP); Jenna Colabianchi; Bill Struyk (Johnson & Johnson), Joanie Cosgrave (Medtronic); Jim Gardner (Pharma); Shannon Beatty (Medimmune) ). I. Call to Order and Introductions Darren Coffman, Director of HERC, called the meeting to order at 9:00 am and welcomed the Commission. There was a round of introductions from each Commission member. Darren also introduced members of staff present. 2. Welcome Sean Kolmer, Health Advisor for the Governor, welcomed the Commission and thanked everyone on behalf of Governor Kitzhaber for agreeing to be on this commission. It is a large commitment and the Governor is especially grateful for the time the members are willing to commit to this group. There has been a long, rich history to this endeavor. It is the hope that this Commission will be the best place for vetting Oregon’s evidence-based guidelines and evidence for health care purchasing. The OHA purchases for about 800,000 lives in Oregon, including the Medicaid population. This commission can also do the due diligence for the commercial market; if evidence is there; it should be available to everyone, not least of all the work of the health care reform effort. Sean also asked that the members remove their individual hats when they come to this table and look objectively at the evidence and make the best decisions for Oregonians. He has the utmost faith that this group will be able to undertake this work. The Governor will be very interested in getting frequent updates from Jeanene and Darren on the work of this group. Jeanene added that this commission’s work is a key aspect of the health care transformation. The Health Policy Board has completed their preliminary proposal of the Coordinated Care Organizations and that proposal will be available soon. HERC January 12, 2012 Page 1 3. Conduct as a Commission Member Linda Grimms, Department of Justice, congratulated everyone and thanked them for acting as public officials. She encouraged everyone to read the guide for public officials enclosed in the packet. All members have been invited here because of their expertise in health care, but if anyone or their family member or business, is getting any benefit (financial or otherwise) through the work that is going to be forthcoming through this committee, it has to be declared. All conflicts or potential conflicts of interest need to be brought to the attention of Darren. She advised members to think through all interactions and if there are any questions, she will be happy to provide clarification. She also reminded members about the importance of confidentiality. Information shared in this committee cannot be used for personal gain or shared outside of this committee. Question: Mark Gibson asked if his association with the Center for Evidence-Based Policy, who does research work for the State of Oregon, will be a conflict of interest. Response: Linda will follow up on this issue and will get back to Darren. Darren also wanted to let the members know that the previous Health Services Commission had contemplated using a “conflict of interest” form which he will share with the group in the next meeting. They had also prepared some policies and guiding documents for people submitting evidence to the commission. He will bring these to the next meeting and the commission can decide the best way for this commission to proceed. 4. Review of Draft Bylaws Darren reviewed the draft HERC By-Laws. Article I, first page, second line, should delete the first half of the word “CommissionCommission”; the word is repeated twice. Article IV, Commission Meetings, paragraph 4 and 5: “Seven (7) Commission Members shall constitute a quorum for the transaction of business. All actions of the Commission shall be expressed by motion or resolution. Official action by the Commission requires the approval of a majority of the Members of the Commission.” To clarify, this will be amended to read” …approval of a majority of the Members of the Commission present at a meeting of the Commission”. That means that if 7 members were present, 4 will constitute a quorum. Question: Vern Saboe asked if there would be a conflict in him serving on both the guidelines committee and the main HERC. Responses: Jeanene does not really think that this will be a conflict because the last HSC used members on the board to help with the technical subcommittees, but she will check on this. MOTION: To approve the HERC By-Laws with amendments noted above. Copy will be posted on the HERC web page. CARRIES 13-0. HERC January 12, 2012 Page 2 5. Election of Chair and Vice-Chair Darren asked for nominations for Chair of the Commission. Kathryn Weit nominated Som Saha. MOTION: To approve Som Saha as Chair of HERC CARRIES 13-0 Som Saha asked for nominations for Vice-Chair of the Commission. Alissa Craft was nominated by Vern Saboe. MOTION: To approve Alyssa Craft as Vice-Chair of HERC CARRIES 13-0 6. Overview of Work to Date Prioritized List of Health Services Darren gave a history of the Prioritized List of Health Services and an overview of its methodology. It represents a rank ordering of condition-treatment pairs using ICD-9-CM, CPT and HCPCS medical codes to define the services on each of the line items on the list. The lists have included numerous public and stakeholder input throughout the processes of their development. A biennial list is sent to actuaries for pricing, the Governor and Legislature for determining the funding level and then sent to CMS for final approval. CMS approved the coverage of 13 fewer lines as of January 1, 2012. The state now covers lines 1-498 of the 692 line items on the list. The last three years of lists are published on our website. Som Saha asked Darren to explain Line 0. The theoretical Line 0 includes those services that are automatically covered before you get to Prioritized List of Services. For example, the general symptoms that an emergency room might code before you get a definitive diagnosis. However, Line 0 seems to be growing and the OHP is finding that it is nearing about 30% of the cost of all claims. The Health Services Commission started working on guidelines around the Line 0 services (eg. MRI’s, PET scans, ancillary services) to try to help contain the costs in Line 0. There are a total of 88 of these guidelines of which about six apply to Line 0. Wiley Chan commented that other metrics for prioritization are available from outside sources, for example, from the National Health Service, that we can take advantage of to help in our work. Som said that thus far, we have used trusted sources of evidence, like from the National Institute of Health Care Effectiveness. They also looked at cost per quality issues. Also in the original Prioritized List the State of Oregon had concerns raised from the ADA because using this methodology took into account only the quality of healthy people vs. the quality of life of people with disabilities. This methodology was tossed aside. Later on, the cost effectiveness methodology was widened to include more than just ranking by this score (eg. Population effects, impact on vulnerable populations, and many other measures). It has always been a list for the Medicaid program but it is the hope that it will be used to define benefit packages beyond use for the Medicaid population. HERC January 12, 2012 Page 3 Value-based services Som explained that in 2007, the Oregon Health Fund Board was created, and part of their charge was to create an essential benefit package. After meeting with stakeholders, the conclusion was to follow the value-based insurance design concept and so a value-based benefits package was created. With the advent of the Accountable Care Act, there are several options for states to use. It is anticipated that the value-based benefit package will be one option in the Health Insurance Exchange. Ariel Smits gave an overview of the value-based services within the value-based benefits package. 20 sets of health care services have been identified as so important they should have little or no cost sharing required. This list of services is now available to use by insurance companies and purchasers. Jeanene confirmed that both PEBB and OEBB have looked at the value-based benefit package with a view to adjusting their benefit design. Darren will be presenting to OEBB later in the day. Evidence-based guidelines Cat Livingston presented an overview of the evidence-based guidelines work. Some potential initial topics have been identified in partnership with the Center for Evidence-based Policy, the Health Leadership Council and Q-Corp. The first guideline, the Evaluation and Management of Low Back Pain, has been completed and it is included in the packet. Also included in the packet is a list of potential topics for further guidelines. A goal of 20-30 evidence-based guidelines has been set for completion by August 2012.
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