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Health | local | Vital Signs

Oregon's Medicaid Health Coordinaters Learn How Well They're Performing

Local coordinated health care organizations have been waiting for a year to see how they’re performing under Oregon’s health care changes.  Tuesday, they found out. 

Some are celebrating, because they’re getting money for meeting all their benchmarks. And others missed benchmarks and are losing some state money as a result.

A few years ago, the feds gave Oregon $2 billion to improve people’s health, and to change the way doctors and hospitals get paid.

Under the old model, the more tests and services a hospital ordered, the more it got paid.  But now, coordinated care organizations, or CCOs, get a lump sum to pay for the health needs of all Oregon Health Plan recipients in their area. That means a CCO can save money if it improves the health of that population. 

“We think we had an outstanding year for the first year of the metrics measurements,” said Phil Greenhill, the CEO of  Western Oregon Advanced Health in Coos Bay.

His CCO got 100 percent of the available incentive pay.

“It’s certainly a true indication of trying to move from a volume delivery of care to understanding a performance outcome and the quality of care we’re delivering to the Medicaid membership,” Greenhill said.

A CCO is an umbrella organization under which many doctors, clinics and hospitals in an area come together to serve Oregon’s Medicaid population.  Under Oregon’s new health-care model, the state holds back 2 percent of monthly payments through the end of the year. 

To get that money, each CCO had to show improvement on various health care measurements. 

Eleven of Oregon’s 15 CCOs did that and will receive 100 percent of the incentive money back.

Greenhill said Western Oregon Advanced Health will plow that money back into health improvements for next year. 

“Certainly it got our attention,” he said. “In our case it was over $1 million. That’s a significant investment, and something that you can do a lot of good with.” 

But even though it received 100 percent of its incentive pay, there are areas that could improve. 

For example, Western Oregon Advanced Health saw its patient immunization rate drop from 67 percent to 49 percent.

Medical director Theresa Muday said it’s too soon to say what that means. 

“We don’t know if the problem is in the reporting, which I suspect may be a piece of this,” Muday said. “We didn’t have a problem with vaccine shortages, but now is a time that we need to really drill down into the information so we can find out where the holes are.” 

While many CCO’s will get all the withheld state money for meeting benchmarks, others will not. 

In Medford, Jackson Care Connect only got 70 percent of the state’s incentive money. 

Regional executive Jennifer Lind said the CCO had problems dealing with many small primary care providers.

“Working with over 50 clinics in a relatively small setting down here has required a lot of relationship building and a lot of individual outreach and plan development that didn’t reflect necessarily in the first year of our measured performance,” Lind said. “But I think will really pay off in the coming years.” 

Lind hasn’t done the math yet, to see how much money Jackson Care Connect left on the table. But she’s taking a philosophical view. 

“It’s always disappointing not to ace the test,” she said. “And I won’t deny that. But I think this is not so much about the dollars.”

Up at the Oregon Health Authority, there’s a sense that this new report is shows that overall, health care organizations are moving in the right direction. 

“We are seeing that both patients and the coordinated care organizations are beginning to see benefits of the coordinated care model,” said Lori Coyner, Oregon Health Authority director of quality and accountability. “CCOs earned payments by doing such things as reducing patient emergency department visits, increasing developmental screenings and increasing primary care.”

Coyner said the CCOs have also seen  increases in the number of clinics and hospitals that have electronic health records — so staff can get a better understanding of a patient’s history. 

She said CCOs have also managed to substantially decrease the number of doctors who schedule baby deliveries early, which translates into fewer medical issues for mother and child. 

But there are some problem areas in the report. For example, many patients say they’re having trouble finding a primary care provider. 

“At this point we haven’t had an opportunity to delve into the reasons,” Coyner said. “We will be working with the transformations center to investigate further with the CCOs areas where there are issues and then learn from the CCOs that did well to establish some best practices that can be spread across the state.”

It’s worth noting that more than 340,000 people accepted into the Oregon Health Plan this year weren’t included in this report. The report only looks at 2013 data. But next year, health care policy wonks are sure to be looking closely at whether all those people who are now on Medicaid, also managed to get access to a doctor.