Coordinated Care Organizations Earn Performance Incentives from Oregon

Coordinated care organizations are delivering improved preventive and primary care at more sustainable costs.

Patients and coordinated care organizations (CCOs) are starting to see the benefits of Oregon’s new model for Medicaid, according to a report released today by the Oregon Health Authority.

Speaking with Lori Coyner, Director of Health Analytics, the response is encouraging: “The OHA is very excited about the initial results and seeing 11 providers meet incentive payments during the first. Right now, we’re regrouping and focusing on how to improve the process further.”

The report lays out how Oregon’s coordinated care organizations scored on health care service measures in 2013. This will mark the first time the state is rewarding CCOs for improving care, rather than only the number or type of services delivered. In addition, Oregon remains on track to stay within the capped rate of growth in Medicaid spending.

Coyner said, “key challenges for next year will be the medicaid expansion as providers take on new enrollees.” The OHA is working with providers to bolster patient education to encourage primary and urgent care visits over the emergency room to ease bandwidth. A success story to emerge from those efforts is that emergency department visits are down by 17% overall. That’s huge progress within a first-year program.

Incentive measures are part of the equation as well. The overall goal of the OHA is to move toward rewarding outcomes with incentive measures rather than sheer volume of services. Based on how they did on the measurements, this week CCOs will receive all or part of the payments that had been held back until now. To earn their full payment, CCOs had to show improvement toward the goals on 17 measures. All CCOs showed improvements and 11 out of 15 met 100 percent of their improvement targets.

Key Findings

The coordinated care model showed large improvements in the following areas for the state’s Medicaid enrollees:

Decreased emergency department visits.

Emergency department visits by people served by CCOs has decreased 17 percent since baseline data were collected in 2011. The corresponding cost of providing services in emergency departments decreased by 19 percent over the same time period.

Developmental screening during the first 36 months of life.

The percentage of children who were screened for the risk of developmental, behavioral and social delays increased from a 2011 baseline of 21 percent to 33 percent in 2013, an increase of 58 percent.

Increased primary care.

Outpatient primary care visits for CCO members increased by 11 percent and spending for primary care and preventive services are up over 20 percent. Enrollment in patient-centered primary care homes has also increased by 52 percent since 2012, the baseline year for that program.

Decreased hospitalization for chronic conditions.

Hospital admissions for congestive heart failure have been reduced by 27 percent, chronic obstructive pulmonary disease by 32 percent and adult asthma by 18 percent.

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