In 2012, the State of Oregon created an accountable care structure to coordinate services for the nearly 1 million members of the Oregon Health Plan, the state’s Medicaid program. Called coordinated care organizations (CCOs), the regional entities bring together physical, behavioral and oral health providers. Now the Oregon Health Authority (OHA) has announced its intent to award 15 organizations contracts to serve as CCOs in the next phase of the program, known as “CCO 2.0.”
Eleven of the organizations are approved to receive five-year contracts, and four organizations are approved to receive one-year contracts. Awardees will sign their contracts, totaling more than $6 billion for the 2020 contract year, in the fall. The new CCO contract services start Jan. 1, 2020.
“We look forward to working together with CCOs and communities to build on the gains of the first six years of health transformation and address gaps and challenges that persist in the state’s health care system,” said OHA Director Patrick Allen, in a statement. “We set a high bar to ensure these CCOs will be ready to advance the goals of reducing costs, improving access to mental health services, rewarding providers for improving health outcomes, and addressing issues outside the doctor’s office that impact health.”
In one example, Health Share of Oregon has served Oregon Health Plan members since CCOs were established in 2012 and now serves more than 300,000 OHP members across Clackamas, Multnomah and Washington counties in the Portland metro area. “Leveraging our relationships with the major healthcare finance and delivery systems in the tri-county area allows us to address and improve behavioral and physical health integration in primary care, at the same time we work to implement value-based payments with each system partner,” said Marni Kuyl, director of Washington County’s Department of Health and Human Services and chair of Health Share’s board of directors, in a statement on the organization’s website. “In addition, Health Share’s unique model creates a platform to implement community-driven health transformation strategies through strong relationships with community-based organizations, the counties, and the health plan and delivery systems.”
Organizations receiving one-year contracts from OHA will be placed on remediation plans and have up to one year to show they can meet the higher expectations of CCO 2.0, with technical support from OHA. OHA will extend those contracts beyond one year for CCOs that show they can meet the goals of CCO 2.0. PrimaryHealth was the only current CCO whose application was denied, due to concerns reported in the organization’s financial review. Three new applicants were also denied contracts.
Nearly 87 percent of Oregon’s 1 million OHP members are enrolled in CCOs. Based on the awards, Oregon Health Plan members in every county in Oregon will have at least one CCO to coordinate their health care. Members in all or part of Clackamas, Jackson (partial), Lane, Multnomah, Polk (partial) and Washington counties will have changes to their CCO choices. Willamette Valley Community Health (WVCH), which serves OHP members in Marion and Polk counties and parts of Benton, Clackamas, Linn and Yamhill counties, did not seek a new contract. WVCH’s contract will end December 31, 2019, and members will transfer to a new CCO.
The applicant evaluation reports are available on OHA’s website. Applications were evaluated in the following areas:
- Care coordination and integration: Ability to coordinate with outside entities (including public and community-based organizations), between levels of care, for special populations of members and to integrate behavioral and oral health services.
- Delivery system transformation: Innovating to improve care delivery and quality (including primary care), access to culturally and linguistically appropriate care, measurement of value and efficiency of services.
- Community engagement: Strength of the Community Engagement Plan and of community engagement in developing the application.
- Clinical and service delivery: Utilization monitoring, ensuring appropriate access to services, clinical review and prior authorization, and approach to addressing complaints and grievances.
- Business administration: CCO business processes, member engagement and outreach, adoption of electronic health records, data systems, and supporting members during transition.
- Finance: Applicant solvency, ownership and affiliations, National Association of Insurance Commissioners (NAIC) reporting, arrangements with pharmacy benefit managers, plans for increasing value-based payments, tracking and reporting of social determinants of health investments and outcomes, managing within the global budget, and cost containment.