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Oct. 11, 2021
Contact: Philip Schmidt, philip.schmidt@dhsoha.state.or.us
The Oregon Health Authority (OHA) released the 2020 Coordinated Care Organization (CCO) Metrics Report, showing the results of Oregon’s Quality Incentive Program. The program rewards CCOs for improving the quality of care provided to Oregon Health Plan members. This model increasingly rewards CCOs for outcomes, rather than utilization of services, and is one of several key health system transformation mechanisms for achieving Oregon’s vision for better health, better care and lower costs.
Due to the COVID-19 pandemic and related disruption to the health care system, however, requirements for CCOs to earn incentives were relaxed for 2020. The Metrics and Scoring Committee elected to modify requirements so that CCOs earned credit for simply reporting on the 13 incentivized measures.
In addition, OHA adjusted the payment structure of the Quality Incentive Program. Rather than withhold a portion of each CCO’s monthly 2020 capitation revenue to fund quality incentives, as originally planned, OHA suspended that withhold starting in April 2020. This made approximately $17 million or more per month available to help CCOs address critical needs that could not wait for later funding. The funds withheld in the first quarter of 2020 were maintained for quality incentive payments, totaling $52.8 million. All 15 CCOs successfully reported on the metrics for 2020, so 100% of each CCO’s quality pool earnings was distributed by June 30, 2021.
“The disruption to Oregon’s health care system due to the COVID-19 pandemic in 2020 cannot be overstated and the CCO metrics report reflects that reality," said Jeremy Vandehey, OHA's director of health policy and analytics. “With that said, we still expect our CCOs to help their members access high-quality care. As CCOs and Oregon adjust to the ongoing pandemic, we need to innovate and to use the flexibility that our system provides to ensure OHP members are connected to the care they need during these challenging times."
Report highlights
Under the unusual and challenging circumstance of 2020, statewide performance showed improvement on four measures, mixed results on one measure, and performance declines on the remaining eight incentivized measures. Although performance on most measures declined in 2020, there are some bright spots in this report.
- Cigarette smoking among CCO members continued to decline, with 13 of 15 CCOs reporting improvements in 2020. The overall smoking rate among CCO members decreased 5 percent from 2019.
- Despite a performance decline in 2020, the percentage of children in foster care who received timely mental, physical and dental health assessments has nearly tripled since 2014.
- Emergency department utilization among members with mental illness continued to decline across all CCOs, which can be an indicator of improved care coordination. Drawing conclusions about this measure for 2020 is challenging, however, given that emergency department use also may have declined because people avoided hospitals because of COVID.
Many of the measures on which performance declined were tied to in-person care, which was severely disrupted by COVID-19. Survey data show that in 2020, about one in three CCO members delayed dental care and about one in five delayed physical health care because of COVID. Some measures, such as childhood immunizations, require in-person care and cannot be delivered virtually. Moreover, although the use of telehealth models expanded through 2020, changes in coverage, reimbursement and practice had to be implemented before that expansion could occur.
In addition to the unforeseeable impacts of COVID, planned changes were implemented for 2020. The Metrics and Scoring Committee retired 10 measures, which are included in an appendix to the report, and added four new measures. Also, 2020 marked the beginning of the “CCO 2.0” contract period. Some CCOs did not continue, and other CCOs began to serve Oregon Health Plan members in new areas of the state. Some performance trendlines in the report are affected by that change.
This year’s report includes break-outs by race and ethnicity for quality measures that are based on a survey of CCO members, the Consumer Assessments of Healthcare Providers and Systems (CAHPS) measures. Most of the other measures include break-outs by household language.
For a detailed report of the CCO metrics and how much each CCO earned through the Quality Incentive Program, visit the OHA Health Policy and Analytics website.
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