Chatter building about plans for fewer CCOs

Anxious chatter is building in Oregon Medicaid ahead of the 2018 CCO procurement about whether there will be a reduced number of CCOs in the state starting in 2019.

For a CCO organization that exists entirely as a result of the Medicaid contract, keeping that contract becomes an existential issue.  So contingency planning is in the early stages in some regions to prepare for potential changes in the OHA procurement model.

Most of the discussion is related to service areas outside of the Portland metro area.  All of it is informal.  However, the idea of fewer CCOs than 16 has been floating around since the launch of the transformational model.

Bruce Goldberg was the Director of the Oregon Health Authority when the 1115 waiver was approved in 2012 and the CCO contracts were let.

“CCO’s were originally thought of as a vehicle to help effect how health care is delivered to bring about greater quality, lower cost, and reduce waste.

As such, initial plans were for there to be ~7 CCO’s to reflect the realities about how health is delivered regionally and to follow the well documented  Dartmouth Atlas health care referral regions.”

Stakeholders helped carve out 16 regions ultimately, however many have thought that some level of future consolidation might make sense, depending on one’s perspective.

One stakeholder commented that the idea probably makes a lot of sense from the view of the OHA.

“This would be much easier to administer for the state, and probably cheaper in terms of administrative staff at both the OHA and various CCO contractors, if there weren’t sixteen different organizations.”

From the view of some of the non-Portland regions, fewer CCOs might be relatively easier to administer in the rural parts of Oregon as well.

Some counties border on or include as many as five different CCOs.  That’s a lot of administrative headache for referral patterns that cross county lines, particularly when the total regional population might be less than the Medicaid enrollment of just one Portland CCO.

However, the driving force does not seem to be administrative simplicity for its own sake, according to the folks I’m hearing from.  The conversation is more about planning for tough conversations that may come in the months ahead.

If the OHA decides to limit the number of contractors, for example, then it makes sense for the more rural CCOs to plan now to be able to meet that demand, so the thinking goes.  Consequently, conversations are focused on administrative integration, reserves contributions, technology platforms, and operational needs.  These are the kinds of things that will take time to iron out among currently separate CCO entities if the OHA moves in the direction it previously envisioned in 2012.

However, the OHA was pretty unequivocal in correspondence with me that no such conversations or initial thinking is taking place there.

“We’re not aware of any conversations about CCO consolidation. Right now, we’re entirely focused on maintaining coverage for Oregon Health Plan members.”

While no formal dialog appears to be underway regarding CCO consolidation, some of the non-Portland CCO stakeholders appear to be in active contingency planning for the time when those conversations may need to be had.

As Bruce Goldberg told me, there may be very good reasons to be thinking creatively about the next procurement based on the collective learnings from previous experience.

“I think the upcoming procurement provides an opportunity to learn from our experience to date and examine a variety of ways to improve on what was started 5 years ago.”