April 12, 2019
The Oregon Health Authority today announced it has hired Washington-based Aggregate Analytics Inc. to conduct a third-party review of a policy proposal to cover more services for Oregon Health Plan members with certain chronic pain conditions.
The proposal, which is under consideration by the Health Evidence Review Commission (HERC), would add new coverage for five conditions: chronic pain due to trauma, other chronic procedural pain, other chronic pain, chronic pain syndrome, and fibromyalgia.
It would expand access to prescription opioids for four of these conditions. In addition, it would add coverage for alternative therapies such as acupuncture, physical therapy and cognitive behavioral therapy. Finally, the proposal would cover supportive, individualized opioid tapers if the patient has fibromyalgia or their opioid prescribing is not aligned with the statewide opioid prescribing guidelines.
OHA Director Patrick Allen asked the HERC to pause deliberations when, in March, agency leadership became aware of potential conflict of interest concerns by a contracted medical consultant to the HERC. He also directed Chief Medical Officer Dr. Dana Hargunani to conduct a top-to-bottom review of the HERC’s conflict of interest policies and procedures.
The scope of Aggregate Analytics’ work will be limited to reviewing whether the OHA proposal reasonably aligns with the clinical evidence that was reviewed during its development. The findings of the analysis will be shared with the HERC at its May 16 meeting. If the HERC adopts the proposal in May, it would be effective Jan. 1, 2020.
“Transparency and integrity are at the core of OHA’s policy-making processes,” Hargunani said. “We need to have confidence that policy recommendations that we make to the HERC were developed objectively and in alignment with the best available evidence. Aggregate Analytics are experts on this body of evidence and are best suited to critically assess this work.”
Dr. Catherine Livingston is a family medicine physician who serves as a contracted medical consultant to the HERC. In her role, she helps develop evidence-based policy recommendations for consideration by the HERC. In addition, she is a co-investigator on two studies evaluating the impact of HERC’s previous decision to expand pain management coverage for people suffering from back pain.
The proposal currently in question, while separate from the back-pain policy, shares a similar framework.
Livingston is not a voting member of the HERC.
About the HERC
The Health Evidence Review Commission reviews medical evidence to prioritize health spending in the Oregon Health Plan and to promote evidence-based medical practice statewide through comparative effectiveness reports, including coverage guidances and multisector interventions, health technology assessments and evidence-based practice guidelines.
The commission consists of 13 governor-appointed and senate-confirmed volunteer members,including five physician representatives (one of whom must be a doctor of osteopathy and another a hospital representative), a dentist, a public health nurse, a behavioral health representative, a provider of complementary and alternative medicine, a retail pharmacist, an insurance industry representative and two consumer representatives.