Oregon Approves Policies to Continue Value-Based Care Push in Medicaid

In 2012, Oregon took steps to transform its Medicaid program through the establishment of coordinated care organizations (CCOs), which bring together physical, behavioral, and dental health providers to coordinate care for patients of the Oregon Health Plan (OHP), the state’s Medicaid program. Recently, the Oregon Health Policy Board (OHPB) approved new policy changes to build upon the successes of the program while addressing challenges and remaining gaps in care.

Oregon’s CCOs are a statewide accountable care model that launched with the implementation of the Affordable Care Act. They were approved through a 1115 Medicaid demonstration waiver. According to OHPB, the state’s 15 CCOs improved access to primary care, reduced emergency department visits by 50%, and saved Oregon an estimated $2.2 billion in avoided healthcare costs over the past 5 years.

CCOs have one global budget for behavioral, physical, and dental health, and the CCOs have flexibility to provide services outside of traditional medical services and to support new models of care. A portion of the budgets are tied to performance and quality and in order to receive those funds, CCOs must meet performance or improvement targets for a set of 17 quality measures.

The CCOs emphasize paying for value using 7 strategies:

• Pay for outcome and value
• Shift focus upstream
• Improve health equity
• Increase access to healthcare
• Enhance care coordination
• Engage stakeholders and community partners
• Measure progress

A recent survey found members of OHP expressed satisfaction with CCOs. While 35% of OHP members said they were unfamiliar with CCOs, of those who were familied with CCOs, 78% said they were satisfied with them.

Now, the OHPB has approved policy changes for new CCO contracts starting in 2020. The proposals, which were approved on October 15, will be used to guide the next 5 years of CCOs and is called “CCO 2.0.”

The CCO 2.0 policy changes focus on 4 key areas:

1. Improve the behavioral health system
2. Increase value and pay for performance
3. Focus on social determinants of health and health equity
4. Maintain sustainable cost growth

The survey of OHP members also gauged their support for the new changes to the CCO contracts. Three-fourths (76%) supported proposals to improve access to behavioral health services, even if they could be expensive and take a while to improve care, and 83% supported proposals to address social factors that affect health, such as housing, food, and transportation.

The new approach will make CCOs responsible for meeting an annual value-based payment target, with 70% of payments to providers under value-based contracts by 2024.