OHA Reports: Oregon CCOs Continue to Advance Health Reform

SALEM, Ore., July 11 -- The Oregon Health Authority issued the following news release:

Oregon CCOs continue to advance health system transformation by focusing on better care and better health outcomes while controlling health care costs.

That's the takeaway from two reports on the performance and stability of Oregon's coordinated care organizations (CCOs) released today by the Oregon Health Authority (OHA): the Oregon Health System Transformation Quarterly Legislative report and the CCO Metrics report.

"Oregon's CCO model is continuing to lead the nation in providing Oregon Health Plan members with better health outcomes through patient-centered coordinated care while controlling costs with a 3.4 percent cost growth cap," said Jon Collins, health analytics director for the Oregon Health Authority. "These reports show that our focus on value and outcomes as well as our focus on accountability is continuing to advance health reforms that improve the lives of Oregonians."

Oregon Health System Transformation Quarterly Legislative Report

The 2016 fourth-quarter legislative report details the state's health system transformation efforts including an update on the Oregon Health Plan demographics, a report on efforts to reduce health disparity, CCO financial information, and an update on eligibility and enrollment efforts.

Key features of the report include:

* A breakdown of the Medicaid expansion population that has been added to OHP through the Affordable Care Act including where they live, their employment status and the services they use.

* A new CCO incentive measure beginning in 2018 that is aimed at addressing health disparities. Emergency department (ED) use has been declining in Oregon since 2011; however, CCO members with severe and persistent mental illness (SPMI) use the ED at more than double the rate of members overall. Therefore, in January 2017 the Metrics and Scoring Committee elected to add ED use among members with SPMI as an incentive measure to address this health disparity. This ties funding to CCO performance, creating more incentive for CCOs to improve outcomes.

* Information about the Behavioral Health Collaborative recommendations and plans to begin transforming the behavioral health system in Oregon.

* An update on the financial performance of Oregon's CCOs. On a statewide basis, CCO operating and total margins have been trending downward from their peak in 2014. This stabilization in margins is expected and while the margins are down since 2015, the overall financial health of Oregon's CCOs remains strong.

More information about the quarterly legislative report can be found on the OHA website (http://www.oregon.gov/oha/HPA/ANALYTICS/Documents/Legislative-Report-Q4-2016.pdf).

2016 CCO Metrics Report

The 2016 CCO Metrics Report details Oregon's pay-for-performance program in which OHA created a quality pool from a percentage of monthly CCO payments to reward performance. To earn their full incentive payment, CCOs have to meet benchmarks or improvement targets on at least 13 of the 18 measures and have at least 60 percent of their members enrolled in a patient-centered primary care home.

The quality pool model rewards CCOs for the quality of care provided to Medicaid members. This model increasingly rewards CCOs for outcomes, rather than use of services, and is one of several key health system transformation mechanisms for achieving Oregon's vision for better health, better care, and lower costs.

As CCOs made large strides on existing measures in the first few years of the program, the aspirational benchmarks, often based on the most exceptional national performance, require focused, sustained efforts to improve quality and be successful on the measures.

This report's results demonstrate that as the quality pool model continues, the targets and benchmarks become even harder to meet or exceed. This ensures that CCOs continue to focus on metrics and strive toward improvement and better health outcomes for members.

The quality pool amount increased to 4.25 percent of monthly payments in 2016, for a total of almost $179 million. While all CCOs showed improvement on a majority of measures, only seven earned 100 percent of their quality pool dollars.

The results from the quality pool model are demonstrating that this is not just another program to pay CCOs for service, but to accelerate CCOs' performance and improve the health outcomes of members.

For a detailed report of the CCO metrics and how much each CCO earned through the pay-for-performance program check out the full report (http://www.oregon.gov/oha/HPA/ANALYTICS-MTX/Documents/CCO-Metrics-2016-Final-Report.pdf).