OHA Technical Forum shares new CCO 2.0 information

On November 19th, the Oregon Health Authority (OHA) held a technical forum to receive feedback on the future changes to coordinated care organization (CCO) structure under the new CCO 2.0 waiver contracts. OHA is creating contracts for the next five years and all qualified applicants will be awarded a contract under an RFA versus RFP procurement. The possible changes would include rate setting methods and distribution of risk profile. The goal is to generate ideas for member enrollment and evolve the rate process, while also continuing to provide excellent care for Oregon Health Plan (OHP) members.

Currently, OHP members can select between plans at enrollment, with those who do not choose automatically assigned to a plan using a member enrollment process. If the member was already enrolled with a COO, they would be enrolled with the same one. Also, family members are kept in a CCO together, but if there is no family member history, unassigned members are evenly distributed between CCOs.

OHA wants to modify this member enrollment tactic, based on CCO and public input and has offered the following proposed approaches:

Auto-assignment approach #1: Make no changes

Members who do not make a selection during open enrollment will be put on their previous plan if the plan is awarded a contract in 2020. If the plan is not awarded a contract, members are auto-assigned between other plans in their area.

Auto-assignment approach #2: Pause previous plan lookback

Any member who does not select a plan during open enrollment would be auto-assigned between any available plans in the area.

Auto-assignment approach #3: Direct auto-assignment from expiring CCOs to new and restructuring CCOs

Members are auto-assigned based on their enrollment history and if that plan was not awarded a contract, their assignment will be directed to new CCOs.

During the upcoming reprocurement, CCOs are going to be chosen through a Request for Application (RFA) process. The new CCO contracts will be fulfilled in January 2020 through 2024. The RFA will contain 2020 capitation rate methodology and process and 2020 statewide rates and proposed area factors.

January 2019: RFA released

February 2019: Letters of intent due

April-June 2019: CCO selection and negotiations

June 2019: CCO contracts awarded

September-December 2019: Readiness review

January 2020: New CCO contracts fulfilled

Chelsea Guest, Actuarial Services Manager, OHA, and Zach Alters, Senior Actuary, Optum, gave a presentation on proposals for rate methodology that aligns with policy goals. They talked about the advantages and considerations of each. One of the core goals is to continue to move towards global budget.

They gave an overview of the current rate methodology, then presented the CCO 2.0 rate proposals.

They discussed key principles for CCO 2.0 rates, such as how OHA wants to manage CCO’s within a global budget, reach a fixed rate of growth, reward CCO’s a reward for quality care in the rate of growth earmark, distribute funds fairly, and emphasize progress toward OHA goals. These goals include sustainable cost growth, improvement of the behavioral health system, focus on social determinants, and increasing value and pay for performance.

The rate setting proposals include:

  • Build the rates on a statewide basis (base data) and risk-adjust based on area factors and health-based risk;
  • Alternate between rebasing the rates and performing a rate update each year;
  • Evaluate the potentially avoidable costs (Prometheus) each year and adjust the statewide base data to meet budget and waiver targets.

The public comment section of the meeting provided meaningful feedback and expressed how they appreciate the thoughtful structure and proposed improvements of CCOs and believe it is the right step moving in the right way.

The final decision will be released when the RFA is distributed. For more information, you can view the CCO 2.0 report here.