CareOregon’s provider network stabilization plan

CareOregon – a nonprofit community benefit company serving approximately 375,000 Oregon Health Plan (Medicaid) and Medicare members – has released a plan detailing how the organization is helping their provider network through the COVID-19 crisis.

The plan comes to the fore in a period when insurers are tasked with thinking about ways to support the health sector as a whole, and provider networks in particular. 

 

 

CareOregon’s provider network includes physical, dental and behavioral health professionals, as well as specialty providers and hospitals. 

The core of our primary care network is made of federally qualified health center (FQHC) clinics, local primary care practices, rural health centers (RHC) and school-based health centers. Many of our clinic partners offer integrated behavioral health to serve members with significant barriers to accessing care,” said CareOregon in a memo. 

Due to its status as a community benefit organization, CareOregon notes that it serves members of the most vulnerable and medically fragile populations in Oregon and that a stable provider network is critical to carrying out services.

CareOregon provider network stabilization plan consists of four key components.

Ensuring access to care   

CareOregon outlined two strategies for ensuring access to care amid the COVID-19 pandemic. The first strategy involves enhancing the ability of providers to execute telehealth and telephonic visits and be reimbursed for the full cost of an in-person visit. 

Next, CareOregon says it is actively preparing for a potential increase in new Medicaid members due to the economic impacts of the pandemic. 

A report published earlier this month estimated that Oregon could see up to 320,000 new Medicaid enrollees. At the same time, the report estimated up to 430,000 individuals could lose their employer-sponsored health insurance. 

Along with the 320,000 new Medicaid enrollees under a “high unemployment scenario”, Oregon could expect to see an additional 31,000 enrolled in the state marketplace, and an additional 78,000 uninsured individuals.

Supporting providers’ financial stability

Central to the stabilization plan released by CareOregon are efforts to provide “stability funding” to their provider network. Under CareOregon’s three-pronged funding methodology, the most vulnerable aspects of their provider network — primary care and behavioral health providers — would be prioritized.

CareOregon laid out their funding methodology as follows:

Revenue stipend: Offsetting lost revenue by paying providers a lump sum advance for visits that would have been conducted in March, April, May and June 2020.

Quality Pool payments: Releasing the majority of state incentive payments earlier than normal to give clinics needed access to money for COVID-19 mitigation.

Alternative payment programs: Delaying the implementation of new alternative payment methodology (APM) contracts and maintaining PMPM payments at current respective clinic levels.”

Conducting outreach to high-risk members to minimize the impact of COVID-19 on member health and network financial stability

The high-risk member outreach component of CareOregon’s stabilization plan includes identifying members in need of additional support to stay healthy while they remain under a stay-at-home order. 

Gov. Kate Brown issued an executive order stipulating that the order “remains in effect until ended by the governor.”

Also included in the outreach portion are efforts to share high-risk population information so clinics can reach out to those most vulnerable. These efforts, said CareOregon, would ensure that those most likely to be negatively impacted by a health outcome know how to access care and other resources available to them.

Using health-related services funding to ensure access to care and limit the spread of COVID-19

CareOregon has committed to using health-related services funding to prioritize for protecting access to non-emergent medical transportation (NEMT) for those with chronic conditions issues typically experienced by vulnerable populations.

The organization’s plan also includes expediting temporary housing support approvals for members suspected to be COVID-19 positive, including helping secure temporary accommodations for houseless members who are at risk for virus transmission.

Finally, CareOregon has committed to working with providers to supply flip phones and simple smart phones to members. As providers increasingly move to delivery of services via telehealth, access to care cannot be achieved without access to phones.

Correction: An earlier version of this story incorrectly stated that CareOregon serves 200,000 members. CareOregon serves 375,000 Medicaid and Medicare members in the Portland metro, north coast and southern Oregon regions.