Promoting and protecting the health and safety of all Idahoans

Office of Healthcare Policy Initiatives

The Office of Healthcare Policy Initiatives was established to house transformation initiatives with Statewide Healthcare Innovation Plan (SHIP) being the first major project. Idaho’s SHIP sought to expand the patient-centered medical home model of care to 165 primary care clinics in Idaho; enhance integration of healthcare records through the Idaho Health Data Exchange (IHDE); and convene payers to encourage a united shift in their approaches to moving from volume to value-based payments.

OHPI has demonstrated the ability to consolidate and coordinate functions and activities in health care policy taking place in Idaho. The office ensures that future initiatives continue this proven path for “bending the curve” of healthcare costs. Because of the competing priorities of the stakeholders engaged in the reform of Idaho’s healthcare delivery system, the Department of Health and Welfare has a unique role in the completion of initiatives in the healthcare policy arena. Its role is to facilitate changes that benefit all Idahoans. Insurance companies, healthcare systems, and other organizations in healthcare also want to see improved outcomes for patients but know that they cannot be the facilitators as there is little trust among the different sectors. Many states have successfully executed multi-stakeholder initiatives through legislation and/or creating a government office dedicated to healthcare policy study and initiative testing. OHPI began operations on February 1, 2015.

OHPI’s Core Functions

The objective of OHPI is to support and promote activities for initiatives that benefit Idahoans’ access to quality care services and lower the total cost of care. This is achieved by taking on ‘current pain points’ of the system such as: 1) the requirement of duplicative provider reporting across multiple payers; 2) clarity of statutes and rules around telehealth services; 3) addressing workforce shortages in rural communities and 4) addressing the remaining statewide barriers that prevent Idaho from advancing its payment reform to fully achieve value in what we pay for healthcare.

The core functions of the OHPI are:

  • Supporting the HTCI and its workgroups that provide subject matter expertise.
  • Providing technical assistance to providers interested in PCMH transformation.
  • Identifying government and private funding opportunities to support healthcare transformation in Idaho that align with our state’s needs.
  • Conducting federal and state healthcare policy analysis for stakeholders and leaders to ensure effective implementation and reduced bureaucracy.
  • Coordinating cross-divisional projects with the Idaho Department of Health and Welfare.
  • Continuing to monitor and report on Idaho’s transition to value-based care through annual reporting.

The History of Healthcare Transformation in Idaho

In 2007, Governor Otter convened the Health Care Summit and formed the Select Committee on Health Care to evaluate Idaho’s healthcare system and recommend ways to make healthcare more affordable. The committee evaluated the recommendations and submitted its report to the governor in 2008. The committee identified patient-centered medical home (PCMH) implementation as a priority. In response, Governor Otter created the Idaho Medical Home Collaborative (IMHC) to pilot test a program in collaboration with Idaho Medicaid, Blue Cross of Idaho, PacificSource, and Regence Blue Shield.

In 2013, a group of committed healthcare stakeholders from around the state created a proposal to test moving away from Idaho’s system that rewarded volume of care to one the encouraged value of care. They worked with the support of Governor Otter and a $3 million planning grant from the Center for Medicare and Medicaid Innovation (CMMI).

Based on that proposal, Idaho found itself with a unique opportunity, when in 2014 it was awarded a $39.6 million Statewide Innovation Model (SIM) grant from CMMI. The grant funded a four-year test that began on February 1, 2015 to implement Idaho’s Statewide Healthcare Innovation Plan. The objectives of SHIP’s redesign of Idaho’s healthcare system were to:

  • Improve Idahoans’ health by strengthening primary care through the patient-centered medical home (PCMH).
  • Evolve from a fee-for-service, volume-based payment system to a value-based payment system that rewards improved health outcomes.

To oversee SHIP and the healthcare transformation process, Governor Otter signed an executive order creating the Idaho Healthcare Coalition (IHC). The IHC was comprised of nearly 50 stakeholders from around the state including public and private payers (insurance companies), legislators, health system leaders, primary care providers, nurses, and representatives from healthcare associations and the community.

It became evident that healthcare delivery transformation would need the strategic and tactical support of an independent group to carry out the efforts required by the enormous SHIP initiative. To that end, the IDHW asked the Idaho Legislature to support the creation of the Office of Healthcare Policy Initiatives.

Using an infrastructure that had already been working on the effectiveness and cost control of healthcare in the state, and using money from the CMMI grant, the OHPI was created to advance healthcare delivery transformation and oversee the implementation of the SHIP grant.

In 2015, OHPI began staffing its office with experts in the areas of health information technology, project management, grants management, and communication.