by Gold Meadows & KVAL.com Staff
Tue, January 28th 2025 at 2:41 PM
Updated Wed, January 29th 2025 at 5:23 PM
Oregon Health Authority: “Three strikes and you’re out” for healthcare costs (Gold Meadows/SBG)
EUGENE, Ore. — Keeping people from affordable healthcare will come at a cost for providers and insurers in Oregon, and so far, the Oregon Health Authority says three health care organizations with unreasonably high cost growth gained their first of three strikes.
OHA’s Sustainable Health Care Cost Growth Target Program, created by the state Legislature in 2019, set a health care spending increase limit of 3.4% per person per year for providers and insurers.
The group’s most recent annual report from May of 2024 shows that between 2021-2022, Moda Health’s Medicare Advantage insurance plans had an 11.6 percent increase.
UHC Company’s Medicare Advantage insurance plans had a 6.4 percent increase, and Oregon Medical Group had a 6.5 percent increase in costs for its patients with commercial health insurance.
However, the report also found 19 of Oregon’s 30 health insurance plans and 29 of the state’s 52 hospital systems and medical groups met the mark during that same time.
“We all know that the healthcare costs are unsustainable and make care out of reach for many. This program was designed with payers and providers at the table to ensure that there is an ability to reasonably grow costs that are acceptable but recognizing that we all need to work together to move towards a system that is more sustainable and more affordable,” said Clare Peirce-Wrobel, health policy and analytics director, OHA
OHA says of the 28 entities that exceeded the mark, most had acceptable reasons like increasing behavioral health services, higher drug prices, and responding to the COVID 19 pandemic.
The three programs cited for exceeding costs did not have acceptable reasons, and OHA is now implementing accountability measures to stop the high cost trend.
“There’s been a public reporting component of the program for a couple of years. This report is the first time that we’re adding that accountability lens,” said Sarah Bartelmann, cost programs manager, OHA. “We’re saying it was or was not for a good reason–an acceptable reason, and then moving into the future, to those performance improvement plans and those financial penalties. This year is a first strike counting towards three strikes and your out towards eventual financial penalties.”
Penalties will be based on the size of the provider as well as by how much they exceed the target.
The Sustainable Health Care Cost Growth Target Program analyzed data from health insurance companies and other sources to measure spending.
Later this year, in their next round of reporting, OHA says providers who exceed the target may be put on a performance improvement plan where they’ll have to demonstrate how they will get spending under control.