Help us write Oregon's health care transformation story

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Issues and actions in Oregon health today

June 18, 2018

Message from OHA Director Patrick Allen: Help write Oregon’s health care transformation story

Patrick Allen

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.

CCO 2.0: the next chapter in health care transformation

The Oregon Health Authority (OHA) is preparing to write new contracts for CCOs, when contracts for the current 15 CCOs end in 2019. Now we have an opportunity to improve OHP and CCOs for the next five years – we call this process "CCO 2.0". For more than a year, the Oregon Health Policy Board and OHA have gathered input on priorities from Oregonians across the state. This spring OHA launched an online survey, which more than 1,500 OHP members, health care providers and others took. Here’s some of what we heard:

  • More than six in 10 OHP members and nearly eight in 10 non-provider/non-member respondents believe CCOs have met or exceeded their expectations.
  • Respondents ranked primary care, care coordination and children’s health as the top three areas in which CCOs work well.
  • The top three priorities for improvement were: behavioral health, social determinants of health, and health disparities and health equity.

People who attended public forums we held in The Dalles, Medford, Portland and Woodburn voiced similar views, ideas and concerns.

5 big ideas for the future of CCOs

Based on this feedback, OHA staff have developed policy proposals in five major areas (“Big Ideas”) to guide the future of CCOs and sustain Oregon’s health transformation momentum. We’ll bring these big ideas to the Oregon Health Policy Board for approval in September. But first we want to hear your feedback.

5 big ideas bullets only

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


Share your input at a CCO 2.0 Big Ideas meeting

Monday, June 18

Hood River, 6:30-8:30 p.m.

Hood River Inn

1108 E Marina Drive

Tuesday, June 19

Hermiston, 11 to 1 p.m.

Eastern Oregon Trade and Event Center

1750 E Airport Road

Ontario, 6:30-8:30 p.m.

Treasure Valley Community College, Weese Building, Room 110

650 College Blvd

Wednesday, June 20

Bend, noon to 2 p.m.

Central Oregon Community College, Health Careers Building

2600 NW College Way

Thursday, June 21

Portland, 6-8 p.m.

Madison High School

2735 NE 82nd Ave

Tuesday, June 26

Corvallis, 12:30-2:30 p.m.

Oregon State University LaSells Stewart Center

875 SW 26th Street

Springfield, 6-8 p.m.

Holiday Inn

919 Kruse Way

Wednesday, June 27

Astoria, 11 a.m. to 1 p.m.

Astoria Armory

1636 Exchange Street

Coos Bay, 7-9 p.m.

Red Lion Inn

1313 N Bayshore Drive

Thursday, June 28

Klamath Falls, 12:30-2:30 p.m.

Henley Elementary School

8227 Highway 39

Spanish language interpretation services will be available at the meetings.