Saturday, February 25, 2012

Oregon's Plans for CCOs

The 2011 Oregon legislature created Coordinated Care Organizations (CCO) through House Bill 3650 requiring the Oregon Health Authority (OHA) to develop a proposal for CCOs. To help create the Implementation Proposal over the months, more than 1,200 Oregonians provided input through eight community meetings that were held in the state and another 133 people met in four targeted work groups to make recommendations on how to implement CCOs in local communities.

The Oregon Health Policy Board (OHPB) a nine member citizen board serving as the policy-making and oversight body for OHA held a meeting January 24, 2012 to approve the final CCO Implementation Proposal. On February 1, 2012, the proposal was delivered to the legislature.

The next order of business is for the state legislature to approve the proposal and if approved, the state will apply for the required permissions and waivers needed from CMS. In the March to June 2012 framework, OHA implementation planning will take place and should have the first CCOs certified and enrolling members by July 2012.

The vision is that a CCO in a community would be responsible for coordinating all of the mental, physical, and dental care for Oregon Health Plan (Medicaid) members through collaborative relationships. The legislation provides for flexibility to set CCOs up in a way that will work best locally because the delivery of healthcare needs may differ from community to community.

A third party analysis found that by implementing CCOs, Oregon could save a significant portion of projected Medicaid costs in the short and long term. Savings would be more than one billion total funds within three years and more than $3.1 billion total fund expenditures over the next five years.

The CCO model would offer local control, focus on prevention, provide for community health workers, establish patient-centered primary care homes, have one point of accountability, integrate physical and behavioral health with a primary care provider working with mental health professionals to reduce administrative overhead, operate on a global budget, and use Electronic Health Records.

In general under the proposal, local providers would have the means and incentives to work together for the population they serve. There would be more flexibility for preventive care and chronic disease management. The CCOs would manage a global budget and if performance standards were met, providers could share in the savings.

The OHPB requested that the Oregon Health Information Technology Oversight Council (HITOC) provide advice on what CCOs will need electronically to operate efficiently:

• CCOs will need to help providers adopt meaningful use of EHRs

• Facilitate the exchange of information utilizing HIEs and insure that every provider is ether registered with a statewide or local direct-enabled health information service provider

• CCOs will need to leverage HIT tools to transform from a volume-based delivery system to a value-based system.

• CCOs need to assess provider performance, effectiveness, cost-efficiency of treatment, look at quality reporting, and provide for not only for HIT but also for telehealth, and mobile devices

The next legislative steps in 2012 are to vote on a proposal to allow OHA and the Department of Consumer and Business Services to share information, so that CCOs will not have to submit financial reports to both agencies, to continue current protections that prohibit discrimination of providers based solely on their license type in the CCO environment, and require OHA to report quarterly on the implementation of CCOs through 2017.

Go to to view the final CCO Implementation Proposal that was submitted.