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Issues and actions in Oregon health today

January 30, 2018

Voters approve Measure 101

The Oregon Health Authority will move forward and implement the assessments voters approved in Measure 101. Measure 101 raises revenue that offsets cuts to vital health programs, including health coverage for more than 350,000 Oregonians enrolled in the Oregon Health Plan through the Medicaid expansion. Oregon’s health reforms have saved taxpayers more than $2.2 billion in the past five years, while improving health and quality measures.

Study says Oregon’s Medicaid reform efforts largely successful; more work remains

An independent evaluation of Oregon’s Medicaid waiver concluded that coordinated care organizations came up with innovative ways of providing care and slowed health care spending between 2012 and 2017.

Oregon's coordinated care organizations (CCOs) are charged with transforming health care delivery for nearly 1 million Oregonians under the waiver from the U.S. Centers for Medicare and Medicaid Services (CMS) that was in effect 2012-2017.

The evaluation by researchers at OHSU’s Center for Health Systems Effectiveness found that the 16 CCOs found creative ways of improving their local members' health, such as increasing vaccination rates. At the same time, per capita spending for CCO members grew at a slower rate than per capita spending for Medicaid enrollees next door in Washington state.

However, evaluators noted that “more work remains” over the next five years to continue Oregon’s progress in limiting spending and improving quality and access.

Under the waiver, CCOs are accountable for the health care spending and outcomes of their members. CCOs are locally governed and responsible for managing physical, behavioral, and oral health care for their members.

“The evaluation validates our practice of rewarding CCOs for improving the health of their members,” says Chris DeMars, administrator of OHA’s Transformation Center, which provides support and guidance to CCOs as the hub of innovation and quality improvement for OHA’s health system transformation efforts.

“More work remains, particularly in the integration of behavioral, oral and physical health, confronting the cost of prescription drugs, and increasing the use of value-based payments for CCOs and providers," says OHSU's John McConnell, Ph.D. "However, the Oregon Health Authority and CCOs have created the infrastructure that may be well suited to address these issues over the next five years.”

The full report is available on the OHA website.

OHA works with providers to prevent disruption in care for FamilyCare members

Portland-area health care providers who serve FamilyCare members should continue to see patients, but cannot request deposits, out-of-pocket payments or unauthorized copays, according to a recently issued guidance from OHA.

In December FamilyCare announced it would close its coordinated care plan, which serves 113,000 Oregon Health Plan members. FamilyCare agreed to remain in the market through January 31, 2018, to help transition members to new CCOs – Health Share, Willamette Valley Community Health and Yamhill Community Care. Earlier this month FamilyCare began providing members’ new CCOs patient-level data to help maintain continuity of care for patients and providers. OHA held two town hall meetings for FamilyCare providers to discuss the transition. In a fact sheet distributed to providers, OHA staff encouraged providers to: Continue to see patients. Please do not cancel appointments or deny scheduling future appointments. Continue to follow the normal processes for prior authorizations, treatment plans, referrals, and other services. Providers will be reimbursed by the appropriate CCO for services authorized prior to and after January 31. Do not bill OHP members for missed appointments, balances, or covered services, except in specific situations allowed under state regulations. You cannot bill OHP members except for limited situations  Members, health care providers and community partners can stay up-to-date on news related to FamilyCare’s closure at the FamilyCare transition web page. The web page includes information about member open houses, hotlines and FAQs. You can also find a recording and slides from OHA’s recent webinar on CCO rates. OHP members with questions (or who want to change CCOs) can also call OHP’s client services line at 800-273-0557 (TTY 711).

OHA finalizes 2018 CCO rates

The Oregon Health Authority has finalized 2018 capitation rates for coordinated care organizations (CCOs) and has submitted additional documentation to the Centers for Medicare & Medicaid Services (CMS) to support these rates.

The additional documentation addresses recommendations from two independent reviews that call on OHA to provide more detailed information about how it developed the 2018 CCO capitation rates.

This includes more information about how CCOs' medical loss ratio is considered in rate development, an analysis of CCO spending growth and a comparison of provider reimbursement rates.