For more than two decades, one issue has been at the top of the list of problems worrying Americans: health care. As a nation, we spend more for health care per person than people in other industrialized countries. Yet on many measures we suffer poorer health and our system is hard for consumers to navigate.

In Oregon, we’re writing a different story. Five years ago Oregon launched an innovative solution to improve care for the 1 million people on the Oregon Health Plan: coordinated care organizations (CCOs). CCOs are designed to improve health and reduce costs by providing more integrated, flexible and innovative services. They are rewarded for achieving specific health outcomes and quality measures. They are locally governed and accountable to their communities. In the first five years, Oregon’s CCOs have shown promising results:

• Better health: In the past five years, more OHP members report being in better health.
• Better care: The state’s health care system is delivering less “low value” care, like unneeded emergency room visits. More children and teens are receiving immunizations and preventive care. Opioid deaths have declined and mental health screenings have increased.
• Lower costs: Taxpayers have saved $2.2 billion in health care costs, freeing up state dollars for schools, public safety and other services.

You can help write Oregon’s ongoing health transformation story. Over the next two weeks I’ll visit 10 communities (Astoria, Bend, Coos Bay, Corvallis, Hermiston, Hood River, Klamath Falls, Ontario, Portland and Springfield) to discuss the future of OHP and the next generation of CCOs. I need your feedback on how far Oregon’s health transformation has come, where we’re going, and ways we can improve care, get better outcomes and reduce costs. I hope you’ll join us and share your views.

Here are the big ideas we want to discuss with you:

1.     Improve behavioral health: Require CCOs to make sure members have immediate access to mental health and addiction services (behavioral health) without having to navigate the system on their own.

What it might look like:

• Set targets for better behavioral health outcomes (e.g., no children spending days in an emergency room due to a mental health crisis).
• Pay for “warm handoffs” between physical and behavioral health providers.
• Require CCOs to offer OHP members more provider choices when they need behavioral health care.
  

2.     Address social factors that affect health and reduce health disparities: Give more OHP members help with housing, food, transportation and other supports that promote good health. Require CCOs to do more to ensure better health for everyone in the community.

What it might look like:

• Require CCOs to spend a larger portion of their budgets on social factors that can lead to poor health (e.g., pay for a housing case manager at a local nonprofit).
• Require CCOs to increase use of traditional health workers like peer support specialists and doulas.
• Require CCOs to dedicate staff and resources to improve health equity.
• Require CCOs to work with non-profit hospitals, local health departments and other CCOs in the same area on a common plan to address social factors.
  

3.     Reduce health care costs: Keep OHP costs in line with overall cost-of-living increases. (Today Oregon’s goal is to keep OHP costs below health care inflation, which is higher.)

What it might look like:

• Set lower spending targets.
• Give CCOs more financial rewards to improve health and save costs.
• Help CCOs purchase lower cost drugs.
  

4.     Pay for better health: More health care providers are paid for improving member health and cost savings, instead of the number of visits or services they provide. This is called "value-based payment."

What it might look like:

• Require CCOs to meet a target for the number of providers who are paid based on health care quality and results (value), not just visits.
• By 2024 require 70 percent of CCO payments to be based on value.
• Require CCOs to make value-based payments to certain primary care clinics.
• Have CCOs work with public employee and commercial health insurance plans to expand value-based payment in all markets.
  

5.     Strengthen transparency and accountability: Ensure CCOs are more accountable to OHP members and their communities.

What it might look like:

• Require CCOs to have two community representatives (which may be OHP members) on their boards.
• Require CCO advisory committees to reflect the demographics of their communities.
• Make more CCO cost, quality and payment data publicly available.
  

If you can’t attend an upcoming CCO 2.0 meeting, you can take our CCO 2.0 Big Ideas survey. We look forward to hearing your feedback in person or online!

Patrick Allen, OHA Director