Sunday, July 29, 2012

OHA Approves Eight CCOs

The Oregon Health Authority (OHA) recently approved eight new Coordinated Care Organizations (CCOs) to provide care to more than 650,000 low income enrollees in the Oregon Health Plan/Medicaid. The eight certified CCOs are contracted to begin enrolling people August 1st with additional CCOs expected to be certified and to begin providing services later in 2012. 

Key to the services provided, the CCOs will coordinate mental and physical healthcare and focus on prevention. The CCOs will especially support patients with chronic conditions so that the patients are taking appropriate medications and are managing their appointments. One example of where an excellent opportunity exists for coordinated care is in the management of diabetes.

Under the new model, Oregon has agreed to reduce Medicaid inflation by two percentage points within two years by focusing on improving the health of clients to reduce unnecessary expenditures. The agreement calls for saving $11 billion over the next decade.

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 $1 billion total fund dollars within three years and more than $3.1 billion total fund expenditures over the next five years.

Approximately 60 percent of Oregon Medicaid dollars are paid by the federal government through a $1.9 billion federal funding pact provided over five years. Governor Kitzhaber and state officials are working with CMS on federal waivers to allow CCOs the flexibility to manage care for the best health outcomes. The Governor is also discussing the possibility of financial investments through CCOs from the federal government in anticipation of future cost reductions.

The CCO AllCare Health Plan Inc. headquartered in Grants Pass, a town of 34,500 nestled in several mountain river valleys in Southern Oregon, represents 23,000 Oregon Health Plan members. The plan has contracts with 1,000 local healthcare providers which roughly includes 95 percent of the area’s physicians and also works with five different hospital systems. Although AllCare is located in a small town, they have implemented managed care concepts, EHRs, and the primary care patient-entered medical home.

AllCare in coordinating care will emphasize sharing treatment plans, exchanging information electronically, working in teams, incentivizing wellness and preventive medicine programs, reducing visits to the emergency rooms, and prioritizing primary care.

Other CCOs include, FamilyCare, Inc., Intercommunity Health Network CCO, PacificSource Community Solutions, Inc., Trillium Community Health Plan, Umpqua Health Alliance, Western Oregon Advanced Health, LLC and Willamette Valley Community Health, LLC.

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