2017 CCO metrics report shows improvements

The Oregon Health Authority (OHA) has released the 2017 CCO Metrics Report, which shows that all Coordinated Care Organizations (CCOs) have made improvements on a majority of measures.

“What we’ve seen over the past five years is that incentives work,” said Jeremy Vandehey, OHA’s director of health policy and analytics. “They are driving improvement in the care that Oregonians receive and helping to improve the health of our communities.”

CCOs are paid based on outcomes, not for utilization of services. In order to receive the full incentive payment, CCOS have to meet benchmarks or improvement targets on at least 12 out of 16 measures and have at least 60 percent of their members enrolled in a patient-centered primary care home.

Out of the 16 CCOs, 14 earned 100 percent of their quality pool dollars. Advanced Health and Cascade Health Alliance did not earn 100 percent of their quality pool dollars. The quality pool amount was 4.25 percent of monthly payments, which totaled more than $178 million.

CCOs also had the opportunity to receive challenge funds, money left over after the quality pool funding is distributed. There was $2.4 million in challenge pool funds in 2017. In order to receive challenge funds, CCOs had to meet the benchmark or improvement target for

  • Depression screening and follow-up plan
  • Developmental screenings
  • Effective contraception use

All CCOs met all three of the challenge measures, except for Cascade Health Alliance which did not met the measures for depression screening and follow-up.

While the distribution of quality pool dollars by CCO appears to have a wide range, with under $2 million for PrimaryHealth of Josephine County to over $43 million for Health Share of Oregon, the distribution of funds earned per member has a much smaller range. Cascade Health Alliance earned $153 per member while Eastern Oregon CCO earned $262 per member.

The incentive measure benchmarks are aspirational goals, so CCOs are only expected to make improvements toward the benchmarks each year. Generally, to qualify for quality pool payments, CCOs must make a 10 percent reduction in the gap between the baseline and the benchmark.

Overall, CCOs saw improvements in the majority of CCO incentive measures and in the state quality and CMS core measures.