Oregon’s Medicaid Coordinated Care Organizations
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.