Breaking news: Federal officials renew health transformation in Oregon

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January 13, 2017

Breaking news: Federal officials renew health transformation in Oregon

Today the federal government approved Oregon’s federal Medicaid waiver application to continue the Oregon Health Plan—Oregon’s Medicaid program—for another five years. The Oregon Health Plan (OHP) covers over 1 million low-income Oregonians who are struggling to make ends meet. This is the largest health plan in the state and covers one in four Oregonians and almost 40 percent in some rural counties.

Highlights of renewed waiver

This approval enables Oregon to continue its innovative model of health care for OHP members and maintain the gains the state has made in the past five years to improve the integration, coordination and quality of care. These reforms have saved hundreds of millions of dollars in health costs for state and federal taxpayers.

Under the agreement, Oregon will continue to:

  • Integrate care: Provide integrated physical, behavioral and oral health care services to OHP members through coordinated care organizations (CCOs).

  • Advance the coordinated care model: The waiver maintains the coordinated care model and promotes payment for value rather than volume of services. These models will continue to allow Oregon to improve quality and outcomes and hold down costs to a sustainable rate of growth.

  • Promote increased investments in health-related and flexible services. The waiver provides clarity on how non-traditional services that improve health are accounted for in global budgets. CCOs will be encouraged to invest in services that improve quality and outcomes, and CCOs that reduce costs through use of these services can receive financial incentives to offset those cost reductions.

Approval enables Oregon to continue improvements in care and cost containment

In the past five years, Oregon has made significant progress toward the triple aim of better health, better care and lower cost:

  • Providing care at the right time and place: Avoidable emergency department use decreased by nearly 50 percent over five years.

  • Better outcomes and care: Hospital readmissions have been cut by a third. Substance misuse assessments, developmental screening and timely prenatal care have all increased.

  • Lower costs: Federal and state governments saved $1.4 billion in Medicaid costs just since 2012 and have avoided billions more since the inception of the Oregon Health Plan over two decades ago. Oregon’s health reforms are projected to save a total of $10.5 billion between 2012 and 2022 by holding down cost growth to not more than 3.4 percent per member per year.

Waiver provides stability and continuity for Oregon’s health system

Oregon initiated early renewal talks with federal officials last year, in anticipation of a new administration taking office. Normal waiver approvals take a year or longer to complete and this renewal was completed within six months. Governor Brown and her staff and Oregon Health Authority officials have worked intensively with Centers for Medicare & Medicaid Services (CMS) Administrator Andy Slavitt and his entire staff to get this done.

Renewal of Oregon’s waiver provides stability for the state’s health system. While Congress debates the repeal of the Affordable Care Act (ACA), today’s waiver renewal is a key validation and continuation of Oregon’s model of care.