Oregon’s Medicaid Coordinated Care Organizations

Abstract

In 2012, the state of Oregon transformed its Medicaid program by establishing 16 “coordinated care organizations,” or CCOs, to provide comprehensive care for its Medicaid population. Coordinated care organizations can be considered a type of accountable care organization (ACO): they are locally governed; are accountable for access, quality, and health spending; and emphasize primary care medical homes. However, CCOs differ from most Medicare and commercial ACOs in their acceptance of full financial risk in the form of a global budget. Coordinated care organizations are also required to integrate financing and delivery systems for a broad scope of services, including mental health, addiction, and dental services. Approximately 90% of the state’s 1.1 million Medicaid enrollees now receive care through CCOs that take a variety of forms that reflect the local context. These CCOs include a mix of for-profit and not-for-profit organizations and vary in the size of the population covered (from fewer than 11 000 enrollees to more than 200 000 enrollees). Some CCOs were formed out of previous Medicaid managed care organizations, whereas others were created out of new alliances and partnerships.

Insights Results

Cost outcomes

Approximately 90% of the state’s 1.1 million Medicaid enrollees now receive care through care coordination organizations (CCOs) that take a variety of forms that reflect the local context

Compared with a 2011 baseline, the Oregon Health Authority reported that per-member per-month spending for inpatient care had decreased in 2014 by 14.8%

Per-member per-month spending on outpatient care was also lower, by 2.4%. However, outpatient spending trends masked a 19.2% increase in spending on primary care services—a change some observers might find encouraging, given the historical access challenges for the Medicaid population

Thirteen CCOs received 100% of their bonus payments, and the remaining 3 CCOs received at least 60% of their bonus payments. In total, the state paid out more than $128 million to CCOs in 2014—approximately $150 for every Medicaid enrollee managed by the CCOs
Care/quality outcomes

One of the most substantial improvements occurred in the rate of screening, brief intervention, and referral to treatment for alcohol and substance use, which moved from a statewide average of 0.1% in 2011 to 7.3% in 2014

CCOs also demonstrated large increases in the %age of their patients enrolled in a recognized patient-centered primary care home (PCPCH), moving from a statewide average of 51.8% in 2012 to 81.0% in 2014

Immunizations for children and adolescents and tobacco cessation efforts improved over the 2011–2014 time period. But rates of chlamydia screening, cervical cancer screening, and well-child visits in the first 15 months declined
Future considerations

Longer-term efforts to keep the growth rate of healthcare expenditures at 3.4% and improve quality may require more substantial changes in the delivery system