Expansions and competition mark Oregon CCO Letters of Intent

Oregon Medicaid Coordinated Care Organization (CCO) Letters of Intent (LOI) are in, and significant changes are afoot.

With strong bipartisan support for the CCO experiment in Salem and funding levels seeming relatively secure under Democratic supermajorities, several players are proposing to expand their Medicaid business.

There also could be – depending on one’s point of view – greater competition for CCO members, or, for the first time in some areas, CCO member choices. But Health Share’s future, based on LOIs, remains an open question.

 The following proposed significant territorial expansions:

  • Moda
  • PacificSource
  • Umpqua Health Alliance
  • Advanced Health
  • Primary Health
  • Providence

Moda, which manages Eastern Oregon CCO, proposes to enter, with three separate LOIs: Lane County; tri-county (Washington, Clackamas and Multnomah Counties) Portland; and the Northwest Coast (Tillamook, Clatsop and Columbia Counties).

PacificSource Community Solutions proposes to expand its Columbia Gorge CCO – presently Hood River and Wasco Counties – to also include Sherman, Gilliam, and Wheeler Counties.

Umpqua proposes to service all of Lane County, which it now partly services.

Southwest Oregon’s Advanced Health, currently serving Coos County and a small part of Lane County, proposes also to serve Curry County.

Primary Health, currently serving Josephine and parts of Jackson County, proposes to serve all of Jackson County.

Providence Health Assurance, in a single LOI, proposes to service tri-county Metro Portland plus Hood River, Clatsop, and Jackson Counties.

Potential new competitors:

Trillium Community Health Plan could have three new competitors in Lane County: Moda, PacificSource, and Umpqua Health Alliance.

AllCare will face competition from Advanced Health in Curry County.

Jackson Care Connect, administered by CareOregon, could face competition from Primary Health.

Metro Portland gets curiouser and curiouser: Health Share filed an LOI to continue to serve Metropolitan Portland, and it argued in an announcement that this would be “the least disruptive option” for both its members and contracted providers.

Health Share founding partners CareOregon, PacificSource (half-owned by Legacy Health) and Kaiser also filed tri-county LOIs, which Health Share in its announcement characterized as “precautionary measures” so they may continue serving OHP members “regardless of what may transpire in coming months.”

Is it foreshadowing, or just prudent contingency planning? Meantime, Moda – which is not a Health Share “partner organization” – evidently plans to compete.

The biggest takeaway from all these Letters of Intent:

The Oregon Medicaid market continues to offer opportunity for savvy Medicaid operators.

If they haven’t entirely solved the CCO model, it is solid enough that, overall, CCO operators feel confident in building on that foundation and continue to push toward better population health.