With the creation of Coordinated Care Organizations (CCOs) came regulations to ensure progress toward the Triple Aim:better health, better care, and lower cost for Oregonians enrolled in the Oregon Health Plan. One of the ways to hold CCOs accountable for positive health outcomes was to provide “health metrics” tied to a financial incentive for CCOs, which can in turn be used to reward providers for helping meet these population health goals.

Each year, the Oregon Health Authority (OHA) withholds a portion of CCOs’ global budget, which can be earned back based on achieving these health metrics. This mechanism is one way that CCOs are held responsible for tracking and improving preventive care, with the ultimate goal of keeping people healthier and out of the emergency department.

Each metric is carefully chosen by OHA’s Metrics and Scoring Committee, and metrics are revised ever year. Once all the CCOs have established systems that have proven effective in addressing a specific metric, that metric is retired, and a new one is created. CCOs have flexibility in what they can do with this money when they receive it on a normal schedule, allowing them to pass a bonus on to their providers and other stakeholders.

With the outbreak of the novel coronavirus creating a cash crunch across the health care system, OHA made the decision to release 60 percent of these payments to CCOs by March 31, a couple months earlier than normal. This allows CCOs to respond to the emergency by making community investments that are directly related to COVID-19.

So, what will our state’s CCOs do with this money, and how will it be regulated? Once the OHA shared that these payments would be released to CCOs, they quickly followed with a requirement that CCOs complete a document discussing the different COVID-19 community investments that they will be making over the course of this pandemic that was due back to the authority by April 10.

COHO CCOs got to work making hard decisions about what community needs were greatest, and what needs would continue to pop up over the next several months as the virus progresses. OHA encouraged CCOs to focus on COVID-19 related areas of need, and requested that each CCO provide an overview of the methodology used to distribute the funds, information on entities receiving the funds, an estimate or range of the expected distribution, a summary of the extent to which distributions were based on previous contracts, a summary of the extent to which distributions were based solely due to COVID-19, a timeline of when distributions were made if possible, and an estimate of any money not distributed and the reason why.

By the end of June 2020, each CCO will also be responsible for providing a final accounting of the distribution of these funds into their community, including explanations for major deviations from the plans provided to the OHA in April.

COHO CCOs worked in collaboration with their Community Advisory Councils, board members, providers, and other members of the community in order to make these incredibly important decisions about where in the community these funds will be invested.

While we don’t have a complete list available of where our CCOs will be investing their money, we know they are doing what is best for their communities! In a few weeks, we look forward to publishing an article that details several of the investments made by CCOs using these funds.

For years, health care reform has been a major platform for many candidates running for public office, as well as a key legislative priority for many Oregon legislators. Whether it’s decreasing the prices of pharmaceutical drugs, increasing the number of insured Oregonians, or ensuring underrepresented communities receive the care that they need, we have been fighting for some time to address these issues within our health systems.

As the novel coronavirus spreads through our communities, it has exposed weaknesses in our health delivery system, as well as the structures that govern those systems. It has also shown how Coordinated Care Organizations (CCOs) are able to deploy resources quickly to provide basic resources and keep people out of the hospital.

Indeed, one of the most important lessons we will learn from this pandemic is that our health care system was not fully equipped to handle it. How do we create a system that is able to respond more cohesively and comprehensively in a crisis?

One of the first steps taken during this pandemic was the collaboration of publicly owned hospitals and health systems with those that are privately owned. In every major health industry, public and private businesses and health care providers are coming together to ensure that we decrease the effects of this crisis. In the pharmaceutical industry, corporations and public health entities are working together to find a vaccine or therapy for the virus. Hospitals are coordinating so that public hospitals can discharge patients from their emergency department (ED) for care at private hospitals that may have more capacity. Will this willingness and ability to collaborate make these groups more inclined to compromise on health care transformation?

Another step that was quickly taken by officials was to increase access to telemedicine, by decreasing the barriers to this care. By relaxing rules around privacy (known as HIPAA laws), providers of all types may utilize FaceTime, Google Hangouts, and Skype. Not only were restrictions removed in many states including Oregon, providers will now be reimbursed at the same rate as providers seeing patients in person. Before this move, telemedicine was not something widely utilized in Oregon.

With the uptick in Oregonians projected to utilize OHP and our state’s CCOs rising to the challenge, will more legislators be interested in utilizing OHP at a higher rate, or expanding the coordinated care system? Oregon has never shied away from having the universal health care conversation, but what’s always been missing is how exactly we will achieve that goal. Will some of the changes made during this pandemic answer questions our legislators have previously had about how to deliver universal coverage for all?

We don’t know if any of these changes will stick, but we do know that Oregon’s CCOs have been leading the way in deploying resources to their communities in an unprecedented fashion, allowing them to serve their communities at a much faster rate.

With 360,901 identified cases of the novel coronavirus in our country, the state of New York has been identified as the epicenter of the outbreak and carries more than 130,000 confirmed cases. For weeks, New York Governor Andrew Cuomo has been calling on President Trump to use the Defense Production Act to secure more medical equipment and has also requested that the federal government release the 20,000 ventilators in stockpile to New York.

Despite his many calls for help, New York received only 400 ventilators from the Federal Emergency Management Agency (FEMA). The state is now due to run out of ventilators as early as this week.

Oregon Governor Kate Brown heard his concerns and decided to act.

Thanks to Oregon’s aggressive social distancing measures, Oregon is on the right path to “flattening the curve,” leaving our state in a good position to aid other states that need assistance.

In an official statement, the Governor’s office said, “If Oregon later finds itself in need of ventilators, New York and other states will respond to our call for assistance.” Governor Brown in a later tweet said, “Oregon doesn’t have everything we need to fight COVID-19 – we need more PPE and testing – but we can help today with ventilators. We are all in this together.”

Currently, with the outbreak at its peak in New York, there are more than 15,000 people hospitalized, with more then 4,100 of those people not only in critical care, but also needing access to ventilators.

This unprecedented step taken by Governor Brown to aid another state doesn’t seem to be the last act of good our states will be taking. Shortly after Governor Brown made her decision to send ventilators to New York, Governor Gavin Newsom of California decided to take similar steps by loaning ventilators to states where COVID-19 is taking a heavier toll, like the state of New York.

Not only are our states working together to get each other much-needed ventilators, Governor Newsom announced yesterday that the State of California just inked new deals to manufacture 200 billion N95 masks per month. This huge increase in masks will not only meet the needs of Californians but could help other states with their shortage of personal protective equipment as well.

Oregon Legislators were due for a special session before the novel coronavirus pandemic hit our doorstep to address unfinished business from the 2020 Short Session. Little was accomplished in the short session due to partisan walkouts, and critical budgets remain unpassed. Now that legislators and other public officials are working on economic relief from the COVID-19 pandemic, pressure to call a special session continues to rise.

This begs the question, when will the Governor call a special session, and what legislation will be considered? Will any of the 250+ unpassed bills from last session make a comeback, or will we be focusing solely on the crisis at hand?

We know the Legislature created a Joint Committee on Coronavirus Response, which includes a roster of 16 legislators called upon to assemble a stimulus package for the State of Oregon. This committee held four separate meetings in which legislators heard from industry leaders, agency directors, and experts. Members of the public were encouraged to submit written testimony for legislators to consider.

Now that our legislators have all the information and recommendations they need, it’s time to get down to crafting legislation in the form of a stimulus package. Our sources have shared that the Legislature is working around the clock to find solutions to support Oregonians through this time. It is our understanding that despite the differences our legislators have had in the past, they are working to create a bipartisan bill that will garner support from all legislators even before a special session is called. We are hopeful the Legislature can come to an agreement in the next week or two and call for a single-day session before mid-April.

Do we think that Leadership will allow legislation other than the coronavirus stimulus package? Maybe. But only if that legislation is fully bipartisan and will not cause tension between the parties.

Last week, the federal government passed a stimulus package aptly named the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This policy provides resources for individuals, small businesses, health care providers, hospital systems, corporations, and many more.

We’ve all heard about the federal legislation that will supposedly provide cash payments to Americans, but what does it really do? We went through the bill to see how it will affect people in our state, and in particular, the health care delivery system.

First, the truth about the cash payments to Americans: will every American receive $1,200 being reported in the news? The answer is yes, most adult Americans will have access to this cash payment, though some groups have been left out. According to the exact verbiage, individuals with a social security number earning up to $75,000 (based on 2019 income) will receive rebates of $1,200 per individual and $500 per child under 17. The payments scale down for those earning up to $99,000, and those earning above $99,000 will not be eligible for the rebate. You must have filed your taxes this year or last year to be eligible, and these rebates will only be garnished if back child support is owed.

The CARES Act also bolsters unemployment compensation by adding $600 to every unemployment compensation check, so no one will receive less than $600 per week through July 31, 2020. Medicaid benefits have also been expanded to include those that have been laid off or furloughed without pay due to COVID-19. Those who are self-employed, gig workers, independent contractors, or those with irregular work history are not usually covered, but under the CARES Act, they will be.

Businesses large and small shouldn’t fret! Rolled into the Act is relief in the form of tax credits, loans and loan relief, grants, and other emergency economic programs.

Though the CARES act is mainly an economic stimulus package, it does include rule and regulation changes for health care entities, as well as specific resources for providers, hospitals, and clinics. For example, many hospitals and clinics have significant concerns about cash flow due to the mass cancellations of elective services. The CARES Act creates the opportunity for hospitals to receive accelerated payments, in which qualified facilities can request a lump sum or periodic payments that could reflect up to six months of Medicare services. This direct injection of capital to our health care system is much needed, as hospitals stock up on supplies and continue to pay their nurses, doctors, CNAs, and many others.

This act also increases Medicare reimbursement COVID-19 patient care by 20 percent. This add-on payment recognizes increased costs incurred by providers and will be applied through the duration of the pandemic. Even providers and clinics that do not care for COVID-19 payments will see a two percent increase in Medicare reimbursement through December 31, 2020.

These increases in reimbursement and loan opportunities will help keep providers focused on caring for their patients. Find a more comprehensive list on how this legislation may affect you here.