Lessons learned from two Oregon Coordinated Care Organizations

Two of Oregon's Coordinated Care Organizations (CCO) are coming into their own in their second year of operation, but personnel say that they struggle to meet some state requirements, according to a Health Affairs blog post. The do-or-die process that helped them assemble the institutions on a tight schedule has ended up creating a high turnover and burnout rate, which could jeopardize the institutions' long-term goals. 

Lauren Broffman, associate research scientist at the Center for Outcomes Research and Education at Providence Health and Services, and Kristin Brown, who serves as program manager at the same organization, recounted their findings from a set of interviews conducted with staff and administrators at Health Share of Oregon in Portland and PacificSource Community Solutions in Central Oregon. These interviews were a follow-up to a 2014 post in which the authors interviewed personnel after their first year at attempting to reduce the pattern of recurring admissions that so often occurs with "frequent flyer" patients. Early evidence showed the hospitals making continual progress in the region.

Unlike accountable care organizations, which are federally regulated, CCOs are state institutions aimed at providing top-quality care to regional Medicaid recipients. President Barack Obama's Affordable Care Act mandated the organizations, which have brought together groups of typically competing interests, such as administrators, physicians, caregivers and other personnel, and forced them to collaborate. 

"That these organizations were successfully operational was apparent," said the authors, "round two interviewees spoke less about how to create a CCO and more about what kind of CCO they wanted to be." The fast-paced nature of the CCOs' creation left "lingering challenges," said interviewees. While the state set up a series of high-yield, short-term goals at the outset of the operations, now personnel are ready to think strategically and define the institutions' long-term goals. 

"Oregon has succeeded in shifting risk for Medicaid costs to these regional collaboratives, and many CCO leaders are enjoying the work," wrote Broffman and Brown. Now the facilities must implement long-term strategies for eliminating disparities in care to improve the overall health of their communities. 

To learn more:
- here's the Health Affairs post

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