When Oregon broadened the income limits on its Medicaid program in January 2014, officials expected to see roughly 260,000 new enrollees. That number ended up closer to 400,000.
Even so, the program, known as the Oregon Health Plan, has held true to its pledge to the federal government to cap its annual per-member spending growth rate at 3.4 percent, below that of the 4.4-5.4 percent increases the Oregon Health Authority reports other states are seeing.
The OHA released its first quarterly report Tuesday to the Oregon Legislature on the state’s new system of administering OHP regionally using 16 so-called coordinated care organizations. The report, mandated by the legislation that created CCOs, covers an array of financial and quality performance indicators, all of which OHA has previously reported.
Mark Fairbanks, OHA’s chief financial officer, said the report is meant to provide lawmakers an update on the CCOs so they can decide how to move forward. The OHA is asking for feedback on the report, which will be followed by another, more refined one in about three months.
“It’s communicating: ‘We went to the federal government, we achieved the waiver, we were granted funding, we deployed that funding and what did we get for it?’” Fairbanks said.
Among the key points the OHA highlighted: Avoidable emergency department use among OHP members has dropped by half since 2011. One of the ideas behind Medicaid expansion is to address emerging health care issues in primary care, thereby preventing expensive hospital visits. Leslie Clement, OHA’s director of health policy and analytics, said the CCOs are exceeding expectations in that respect.
The OHA collected baseline data on CCO members in 2013, and saw improvements in some measures in 2014 and again in 2015.
“We were frankly surprised at how much improvement continued in the third year,” Clement said. “I really do think that, generally speaking, we’re really pleased at the progress that’s being made.”
Central Oregon’s CCO met statewide benchmarks on emergency department use in both 2015 and 2014. Last year, 32.6 local members visited an emergency department per 1,000 member months compared with 41.9 in 2014. Member months refers to the number of people enrolled in the program each month.
Leslie Neugebauer, the director of Central Oregon’s CCO, said her organization is still working to decrease avoidable emergency department use. It’s in the process of hiring an emergency department improvement coordinator, for example, who will study strategies for getting people to more appropriate care.
But two groups of CCO members — those who have disabilities and those with mental health diagnoses — are still using emergency departments at high rates, according to the OHA report. Among members with disabilities statewide, 81 members per 1,000-member months used the emergency room in 2015, compared with 43.1 members per 1,000-member months for all OHP members.
About 78 CCO members with mental health diagnoses per 1,000-member months visited emergency rooms that year. Emergency room visits were even more frequent among members with severe and persistent mental illness.
Clement said her team chose to highlight those high-need groups in hopes CCOs will pay more attention to them and make sure they’re connected to primary care.
Central Oregon’s CCO recently received a grant to allow for more integration of behavioral health services into primary care, Neugebauer said. That’s been happening at St. Charles Health System for years, and has been catching on among more primary care providers, she said.
The OHA report lists each CCO’s operating margin and total margin in 2013, 2014 and 2015. While the OHA does not have an explicit operating margin range it directs CCOs to fall within, Fairbanks said they’ve averaged around 5 percent, which is comparable to Medicaid-managed care groups in other states.
PacificSource Community Solutions, Central Oregon’s CCO, had a 2015 operating margin of 8.2 percent. PacificSource’s Columbia Gorge region CCO had the highest operating margin last year at 18.8 percent. PrimaryHealth of Josephine County had the lowest at minus 0.8 percent.
When the CCOs were created, the federal government required that they abide by a so-called medical loss ratio for new enrollees, which required that 80 percent of their revenue went to medical care. CCOs must pay back any money that falls below the 80 percent threshold. This is the first year that rule applies to all CCO members, not just the new ones.
The medical loss ratio for 2017 has not yet been established, Fairbanks said. In 2018, the federal government requires it be 85 percent.
The report also lists CCOs’ corporate status; whether they’re nonprofit or owned by private corporations or limited liability corporations. There has been widespread criticism of the purchase by St. Louis-based Centene Corporation, a Fortune 500 company, of the parent company of Lane County’s CCO. Fairbanks said that’s not what prompted that information’s inclusion in the report.
Fairbanks didn’t say whether the OHA prefers a particular corporate structure for CCOs, but said it plans to take up the question.
“We’re in a position now where we can begin to take a deeper dive on the CCOs and see if we have some best practices or if there is a model or models that we can say is working maybe slightly better than others and why,” he said.
Central Oregon’s CCO is owned by PacificSource, a private, not-for-profit holding company recently created through a partnership with Legacy Health.
More than 1.1 million Oregonians are enrolled in OHP — more than one in four people in the state. Jefferson County in Central Oregon has the state’s highest enrollment rate: 39.3 percent. Clement said while more aggressive outreach efforts could play a small role in that, income is the predominant factor that drives OHP enrollment by county. In Deschutes County, 27.5 percent of residents are enrolled in the program, compared with 33.4 percent in Crook County.
— Reporter: 541-383-0304,