New report finds Oregon CCOs were financially stable last year


Shane Ersland


New financial information reported to the Oregon Health Authority (OHA) from 16 contracted coordinated care organizations (CCOs) show that the state’s CCOs were financially stable and sound in 2021.


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OHA financial analysts also noted high profit margins for some large contracted partners within CCOs. One CCO–Health Share of Oregon–pledged to reinvest $100 million in profits gained by its contracted partners into services for the Oregon Health Plan (OHP) members it serves.

CCOs are responsible for delivering coordinated medical, behavioral and dental benefits and other services to more than 1.1 million members enrolled in the OHP, most of whom are enrolled in Oregon’s Medicaid program. In total, OHP covers more than 1.4 million people in Oregon; as the largest provider of health coverage in the state, nearly 1 in 3 Oregon residents is covered under OHP.

Senate Bill 1041 requires OHA to make the expenditures of a CCO serving OHP members transparent and available to the public. CCO financial reports must be posted by Aug. 1st. Financial statements for all 16 CCOs can be found here, along with additional CCO program financial summaries.

“Oregon’s coordinated care organizations remain financially strong, even as they have taken on more members,” OHA Director Patrick Allen said. “On average, coordinated care organizations spent 90 cents of every dollar on services for members. We want to see CCOs continue to expand their investments in care for members, especially in critical areas where they can make a bigger difference, such as giving more people access to behavioral health treatment and expanding access to supportive housing in communities across Oregon.”

Highlights of the 2021 CCO financial reports include:

  • Operating margins: OHA uses Net Operating Margin to measure the financial performance of the CCOs. Net Operating Margin is calculated from the revenues of the organization less the member medical expenses and administrative costs.  Across the entire CCO system, the 2021 operating margin was 2.1%, up from 1.5% in 2020. Of Oregon’s 16 CCOs, Eastern Oregon CCO reported the highest operating margin of 5.5%. Only Trillium Community Health Plan/Tri-County (operating in the Portland metropolitan region) reported an operating loss, which was 2.9%. However, Trillium’s consolidated operating margin was 5.2% when its Tri-County loss was combined with Trillium Community Health Plan/Lane County’s operating margin of 7.8%.
  • Spending on services for members: Across the system, CCOs spent 90.4% of their income on member services and 7.5% on administrative costs, resulting in the 2.1% operating margin.
  • Enrollment: Membership increased in 15 of the 16 CCOs over the past 18 months. PacificSource-Community Solutions in Lane County reported the largest percentage of increase (44% percent growth). Trillium Community Health Plan/Lane County reported the only decrease (a 2% decline).
  • Health-related services: Health-related services are services that CCOs may provide beyond the standard Medicaid benefits to improve care delivery, member well-being and the health of the community. In 2021, CCO spending on health-related services increased by more than $2.5 million across the system. However, CCO spending declined by $1.44 per member/per month as OHP member enrollment increased during 2021. Umpqua Health Alliance spent the largest amount on health-related services on a per member basis at $158 (total $5.4 million). Cascade Health Alliance spent the least on health-related services at $12 per member (total $0.3 million)

This press release was provided by the Oregon Health Authority.