Lessons Learned

Ms. Fraser closed by sharing some lessons. First, she said, “under-promising so that we can exceed expectations” is crucial. Adding a benefit is much easier than removing one, so if the committee begins with an expansive list of EHB, it will be “virtually impossible to cut it back” should the benefits be found to be unaffordable.

Second, Ms. Fraser expressed strong support for the use of federally funded comparative effectiveness research in benefit decisions. Currently, she said, each provider and each plan is left to figure out these decisions on their own, which results in inconsistent decisions.

To conclude the panel discussion, committee member Mr. Koller asked the panelists whether the committee’s time “would best be spent telling the Feds what to do based on your experiences, doing it for the Feds, or telling the Feds what to tell the states to do?" Dr. Saha replied that the latter option would be the most fruitful; whereas Ms. Fraser noted that regardless of whether states do it or the federal government tells the states what to, the committee should develop mechanisms to ensure some level of consistency. She suggested that if the federal government delegates this work to states, states ought to be given the option of following federal rules and/or joining regional consortia to take advantage of economies of scale and data. Also, if states make these decisions, she said, the states should be required to report them to a publicly available central database. The federal government should track results and publish guidance when the evidence becomes clear that certain treatments are more appropriate than others.

REFERENCES

The Economist. 1998. John Kitzhaber’s prescription. http://www.economist.com/node/160924 (accessed May 10, 2011).

Oregon Health Services Commission. 2007. Prioritization of health services: A report to the Governor and the 74th Oregon Legislative Assembly. Salem, OR: Oregon Health Services Commission.

____. 2011. Prioritized list of health services: April 1, 2011. http://www.oregon.gov/OHA/OHPR/HSC/docs/L/Apr11List.pdf (accessed May 10, 2011).

Smith, J., and S. Saha. 2011. Oregon’s value based benefits package. PowerPoint Presentation to the IOM Committee on the Determination of Essential Health Benefits by Jeanene Smith, Administrator, Office for Oregon Health Policy and Research and Somnath Saha, Staff Physician, Portland VA Medical Center and Chair, Oregon Health Services Commission, Costa Mesa, CA, March 2.



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