Oregon has implemented a statewide accountable care model with the
2012 launch of Coordinated Care Organizations (CCOs). CCOs are partnerships of payers, providers, and
community organizations that work at the community level to provide
coordinated health care for children and adult Oregon Health Plan
Enrollees. CCOs build on pre-existing initiatives in the state
including the Patient-Centered Primary Care Home (PCPCH) Program created in 2009 to enhance primary care across the state by encouraging practices to adopt the medical home model.
A PCPCH Pediatric Standards Advisory Committee was involved in the
creation of the program to ensure the use of appropriate measures for
children. Participating practices are required to uphold medical home
standards related to areas such as access to care, accountability, and
coordination and integration. Oregon also has an approved state plan
amendment to implement Health Homes that build on the PCPCH program and
provide services to Medicaid enrollees with chronic conditions.
Currently, there are 6,618 primary care practitioners participating
in CCOs. Of those, 3,823 (58%) are pediatric clinicians. Over 400,000
clients under the age of 19 have had an encounter with a CCO during
2013.
Sixteen CCOs operate across Oregon and each is provided with a fixed
global budget from the state. This financing strategy gives CCOs the
flexibility to create alternative payment methodologies for providers
and to explore innovative strategies to support transformation based on
the needs within their specific communities. CCOs are required to
implement the requirements for the Patient-Centered Primary Care Home
program as much as possible, and, in addition to providing physical
health care, CCOs also deliver mental health, alcohol/substance abuse,
and dental care services. Furthermore, CCOs are expected to coordinate
with their local Early Learning Hub, newly launched community entities
charged with supporting efforts for education and early childhood
development.
Oregon received a State Innovation Model (SIM) testing grant from
the Center for Medicare and Medicaid Innovation in 2013. A key focus of
the SIM grant, is to support the improvement and spread of the payment
model used by CCOs to other payers beyond Medicaid and to create a Transformation Center
to support the improvement and testing of the CCOs. The Center
provides technical assistance and offers CCOs the opportunity to
participate in learning collaboratives focusing on a variety of issues
such as CCO incentive measures and complex care initiatives.