The challenges and successes of Oregon's Medicaid CCOs

Now three years into its experiment to manage its Medicaid population through 16 coordinated care organizations (CCOs), Oregon has promising results to report yet significant challenges to overcome, according to an opinion piece published in the Journal of the American Medical Association.

About 90 percent of the state's 1.1 million Medicaid enrollees now receive care through a CCO, which include a mix of for-profit and not-for-profit organizations aimed at reducing spending and improving care quality, writes K. John McConnell, Ph.D., of the Oregon Health & Science University's Center for Health Systems Effectiveness and Department of Emergency Medicine.

So far, the state has met its spending targets each year and is on track to meet its overall spending-reduction goal, McConnell writes. Its per-member, per-month inpatient care spending is down 14.8 percent, and its per-member, per-month outpatient care spending is down 2.4 percent. In addition, spending on primary care services is up 19.2 percent, which is encouraging, given the healthcare access challenges faced by the Medicaid population, he adds.

The program has also produced promising results in terms of care quality, McConnell says, noting that 13 of the 16 CCOs received 100 percent of their pay-for-performance bonuses. The rate of screening, brief intervention and referral for alcohol and substance abuse treatment also climbed from .01 percent in 2011 to 7.3 percent in 2014.

A January report from the Oregon Health Authority also noted that the state's CCOs had been able to cut down on hospital admissions and emergency department use for several costly conditions.

However, rates of chlamydia screening, cervical cancer screening and well-child visits all declined in the first 15 months, McConnell writes. Some of the CCOs' early successes also may be attributable to an overall slowdown in healthcare spending, he acknowledges. Indeed, researchers' interviews with staff and administrators at two Oregon CCOs showed that many seemed eager to define the organizations' long-term goals, FierceHealthcare has reported.

These long-term goals will require substantial delivery system reforms, McConnell writes, though he says this will be especially challenging with the influx of Medicaid enrollees through Oregon's expansion of program eligibility under the Affordable Care Act.

To learn more:
- read the opinion piece (subscription required)

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