Highlighted Project: Oregon Coordinated Care Organization Case Studies

Oregon provides testing ground for accountable care in Medicaid

In 2011, the first Accountable Care Organizations for Medicare were launched under the Affordable Care Act. Less than a year later, Oregon launched a massive experiment in healthcare payment reform. Driven by both a desire for reform in Medicaid and a huge budget shortfall, Oregon created 16 new community-based Medicaid managed care organizations. Similar to ACOs, Coordinated Care Organizations (CCOs) are given a capitated payment in exchange for providing measurably better care at a lower price. CCOs are accountable for physical, behavioral, and dental care for Medicaid.

To date, Oregon is the only state that has implemented accountable care within Medicaid on such a wide scale.

That has given CORE's CCO Case Study project funded by Robert Wood Johnson, front row access to the development of two CCOs: Health Share of Oregon in NW Oregon's most populous tri-county area and PacificSource in Central Oregon.

These case studies examine the local context for each CCO such as their organizational cultures and governance. The studies also examined the payment structures strategies it used to meet health quality goals, and consumer engagement tactics.

I think there was a spirit generated out of, well, we're being kind of forced to do this and we do have this obligation to the population, and maybe we could do something different here, and maybe we can do the right thing. We have all been talking about this in our professional careers… but we really never had the ideal conditions to make something happen. - voice from the field

Researchers interested in new payment models may find these case studies useful as they seek to learn the factors and forces that drive outcomes associated with payment reform in Oregon. 

State Leaders – especially those outside Oregon – may find the case studies to be a resource for learning how Oregon's CCO implementation played out on the ground, and they may find they can apply some lessons to policies in development at home.

Methods
Researchers conducted more than 200 interviews with key informants, including CCO executive leadership, members of community advisory councils, CCO members, and state officials. Researchers also attended public meetings and did extensive document analysis.

Major Findings

The full case study report is available here. Overviews of findings have been published in two Health Affairs blog posts. Early reflections from CCO leaders on the challenges of building CCOs from scratch are shared in Year Zero: Leaders at Oregon's CCOs Share Lessons From The Early Days. Two years later, CORE re-visited early trends and patterns and reflected on CCO progress in Year Two: Capturing the Evolution of Oregon's CCOs.

Below are some highlights of the study:

• CCO Leaders were highly motivated to participate in CCO implementation. This came partly in response to political pressure, but also in response to their own desire to improve care for Medicaid members.
• CCOs experienced challenges as they sought to maintain and build relationships among partners while responding to a challenging timeline. At both CCOs under study, "quick wins" such as grant-funded programs proved a valuable means to secure engagement and commitment from community partners.
• The compressed implementation timeline was frustrating for many interviewees, who felt that better quality solutions could have been developed with more time.
• Quality incentives proved influential. Early CCO strategy developed around the incentives, and a large apparatus had to be erected within each CCO to track and monitor performance.
• The extent of payment reform varied widely across the two CCOs. While the global budget is an innovation, that reform has not trickled down to the provider level in all cases. Many providers in the state are still being paid fee-for-service for Medicaid.

For more information about Health Share of Oregon, visit their website.
For more information about PacificSource in Bend, visit their website.

View final case study ›