Oregon is almost a year and a half into its experiment with restructuring its Medicaid system. The idea is to move from a system where health care providers are competitors, to one where providers share budgets and work together.
The CCOs are currently focusing on the people using the majority of the services offered by Oregon’s Medicaid system — called the Oregon Health Plan (OHP). That means most of the reforms are aimed at the 20 percent of OHP members who use 80 percent of its resources.
So far, the results have been promising: emergency room visits are down, and primary care visits are up. Health care policy experts say that’s a good way to save money in the medical system (though some argue the effect of fewer E.R. visits has been overstated.).
But it’s still the beginning of the experiment. CCOs are a long way from meeting certain long-term benchmarks. The state would still like to see improvements in the number of adolescents and young adults getting annual check-ups, in addressing smoking, alcohol, and drug use, and in several other areas.
And with 180,000 new OHP enrollees due to the Affordable Care Act, the CCOs could become taxed. David Labby is Chief Medical Officer for HealthShare Oregon — a Portland-area group that has the largest enrollment of any CCO. He says “we need to reach out to the new members as early as possible to get them engaged in the system before they have a crisis.”
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OPB | Sept. 27, 2016