The Oregon Health Authority on Wednesday released quality metrics and reward-payments data for the state’s 16 coordinated care organizations.
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The influx of new members was due to the Affordable Care Act’s Medicaid expansion, making more people eligible for the program.
The regional CCOs, which manage and pay for the care of Medicaid patients, work with providers to find ways to improve outcomes for patients while lowering costs. By doing so, the organizations meet certain metrics set by the state and receive incentive payments.
OHP has more than 1 million members, and most are enrolled in CCOs, said Lori Coyner, OHA’s director of health analytics.
Salem’s CCO, Willamette Valley Community Health, which has 93,357 members, earned $12.8 million in 2014. The total 2014 incentive funds were $128 million.
The metrics measured include access to care, emergency care utilization, various screenings and electronic health record adoption.
“It’s the second year in a row that we’ve seen many areas of care in the state improve, and that’s quite positive, especially in light of the very large number of new OHP members that came on last year,” Coyner said.
In 2013, CCOs made strides in significantly reducing emergency room utilization and increasing primary care utilization. In 2014, the hundreds of thousands of new members didn’t hinder that progress.
Coyner said CCOs were proactive in reaching out to new members and enrolling them in primary care homes so they knew right away where to access health care, rather than going to the emergency room.
Work remains in screening for alcohol and other substance misuse, Coyner said. Providers have had to change their protocols to include the screening for patients, so it could take some time to hit the benchmark, she said.
Statewide, 7.3 percent of adult patients received screening and intervention for substance abuse in 2014. That’s an improvement from a 0.1 percent baseline in 2011, but far below the benchmark of 13 percent.
In addition, CCOs are working on improving the rate of annual well-care visits for adolescents and young adults. Thirty-two percent of CCO enrollees ages 12-21 received a well-care visit in 2014, an improvement since 2011. However, the benchmark is 57.6 percent.
Barriers to achieving this goal include concerns of confidentiality and pediatricians not being comfortable working with adolescents or young adults, Coyner said. One way providers could make an impact, she said, is expanding their visits for sports physicals, exams required for students to play sports, into well-care visits. The well-care visits could address risky behaviors, mental health, diet and physical activity.
OHA also introduced three new metrics pulled from providers’ electronic health records, rather than claims data. They are controlling high blood pressure, depression screening and follow-up plan, and poor diabetes control.
This marks a move from tracking health care process to health outcomes, Coyner said.
Coordinated care organizations were spearheaded by former Gov. John Kitzhaber, through a pact made with the federal government.
Oregon has promised the federal government that it will reduce projected state and federal Medicaid spending by $11 billion over 10 years and that it will lower the cost curve 2 percent in the next two years. The federal government in exchange gave Oregon $1.9 billion over five years for the transformation efforts.