Report on Oregon Health Plan reform shows improvement in some areas of care, decline in others

Bend Bulletin, June 26, 2014

ER bedIn 2013, Oregon Health Plan patients went to the emergency room less often and were more satisfied with the care they received than in 2011, according to a quarterly report released Tuesday.

This was the first report to show a full year of data since the state launched its massive effort to reform the Oregon Health Plan, the state’s version of Medicaid. Tuesday’s report was the fourth quarterly statement on the effort, the first with performance bonus checks attached.

In 2012, Oregon created 15 regional entities called Coordinated Care Organizations, or CCOs, to administer the Oregon Health Plan and attempt to lower costs and improve health care with new payment contracts and improved coordination among providers.

Central Oregon’s CCO fared well in Tuesday’s report card and earned a $3.52 million performance bonus.

Not all the news in Tuesday’s report was good, however. Access to health care statewide — in other words, getting an appointment to see a doctor quickly — was a challenge in 2013. And although data from this year are not yet available, officials warn that access probably has become worse in 2014, as Oregon Health Plan enrollment has surged.

The plan was expanded Jan. 1, as part of the Affordable Care Act. More than 340,000 new members have enrolled under new income guidelines. Adults who earn less than about $16,100 per year for a single person or $32,900 per year for a family of four are now eligible for coverage.

Beginning this month, CCOs are reimbursed in part based on how well they performed in 17 key performance areas. For scoring purposes, data from 2013 were compared with data from 2011, the year before all of the changes took place.

The Oregon Health Authority withheld 2 percent of the 2013 budget for each CCO. To earn their full payments, CCOs had to show improvement on at least 12 of the 17 measures and have at least 60 percent of patients enrolled in a primary care clinic.

Of the state’s 15 CCOs, 11 — including Central Oregon’s CCO, PacificSource — showed improvements in enough categories to earn back 100 percent of the money withheld.

Money that wasn’t earned back was combined into what the state called a “challenge pool” and divvied up among CCOs according to their scores in four categories. PacificSource was one of three CCOs to improve its performance in each of those four measures.

All told, PacificSource earned 106 percent of its withheld funds, which amounted to just more than $3.52 million, according to Kate Wells, director of community health development for PacificSource.

PacificSource is also the CCO for the Columbia River Gorge region, so that sum will be split between Central Oregon and the Hood River area. Central Oregon will get $2.7 million, according to a news release from PacificSource and the Central Oregon Health Council, the local CCO’s board of directors.

Dan Stevens, senior vice president of government programs for PacificSource, said 60 percent of Central Oregon’s portion of the money will go back into the CCO’s regular budget, to pay for health care for local Oregon Health Plan patients.

The remaining 40 percent of the bonus money will go into what’s being called a “quality fund.” Providers in the region who propose new ideas to improve health care quality may be granted money to fund their projects. Grants will be awarded by the Central Oregon Health Council’s finance committee.

Stevens said the committee hopes to review proposals as soon as July.

PacificSource exceeded benchmarks in four categories: electronic health record adoption, follow-up care for children prescribed medication for attention deficit hyperactivity disorder, timeliness of prenatal care and reduced elective deliveries performed before 39 weeks of gestation.

But PacificSource failed to show improvement over 2011 data in the rates of colorectal cancer screenings, follow-up visits within seven days for patients recently hospitalized for mental illness, and mental and physical health assessments within 60 days for children in Department of Human Services custody.

Also, local Oregon Health Plan patients reported slightly decreased access to care in 2013. An annual patient satisfaction survey found that 80.6 percent of Oregon Health Plan members within PacificSource “thought they received appointments and care when needed” in 2013, down from 81 percent in 2011.

Patients were more satisfied with the care they received, however. In 2013, 83.5 percent of Oregon Health Plan patients in the local CCO said they “received needed information or help and thought they were treated with courtesy and respect” compared with 81 percent in 2011.