The Oregon coordinated care model was implemented in 2012 through “Coordinated Care Organizations” (CCOs), which operate under a Section 1115 waiver, first granted by the Obama Administration. A coordinated care organization is a network of all types of health care providers (physical health care, addictions, and mental health care) who have agreed to work together in their local communities to serve people who receive health care coverage under the Oregon Health Plan (Medicaid). CCOs are focused on prevention and helping people manage chronic conditions, like diabetes. This helps reduce unnecessary emergency room visits and gives people support to be healthy.
CCOs are local. They operate within a global budget that covers mental, physical, and dental care. The global budget can grow at no more than 3.4 percent per member per year. CCOs are accountable for health outcomes of the population they serve. They are governed by a partnership among health care providers, community members, and stakeholders in the health systems that have financial responsibility and risk.
Before CCOs, the system separated physical, behavioral, and other types of care. That made things more difficult for patients and providers and more expensive for the state. CCOs have the flexibility to support new models of care that are patient-centered and team-focused and reduce health disparities. CCOs are able to better coordinate services and also focus on prevention, chronic illness management, and person-centered care. They have flexibility within their budgets to provide services alongside in addition to Medicaid benefits, with the goal of meeting the Triple Aim of better health, better care, and lower costs for the population they serve.
Across Oregon, CCOs are working on a local level to transform the health care delivery system to bring better health, better care, and lower costs to Oregonians. To provide status updates on the state’s progress towards these goals, the Oregon Health Authority (OHA) publishes regular reports showing quality and access data, financial data, and progress toward reaching benchmarks.
Today CCOs provide care to nearly 1.3 million people in Oregon’s Medicaid program. During the first five-year waiver period between 2012 and 2017, this payment/delivery model stayed within the 3.4% growth cap, enrolled over 385,000 more people, met the required outcome and quality metrics, and realized a cumulative total fund savings of over $1 billion.