Coalition for a Healthy Oregon had a successful legislative session, passing into law several of its top priorities. COHO secured full funding for the Oregon Health Plan, maintaining current service level for eligibility and benefits as well as rate of growth (i.e., no cuts to providers). COHO was instrumental in passing legislation related health equity investments, expanding Medicaid coverage to undocumented adults, and a budget note to improve future contracting processes for coordinated care organizations (CCOs).

Sustainable Investments in the Social Determinants of Health and Equity

COHO’s main priority bill, HB 3353, was approved with bipartisan majorities in the House and Senate. HB 3353 asks Oregon Health Authority (OHA) to negotiate with the federal government for certain specific changes to the state’s 1115 Medicaid Waiver, which enables Oregon’s local care delivery model.

Specifically, the requested changes would make 3% of CCOs’ budgets more flexible and increase the proportion of federal match for those dollars, amounting to a $250 million increase of federal funds for local health investments over the next five years.

  • Investments must be made in the social determinants of health and equity or provider reimbursement
  • Strategies must tie into CCOs’ Healthy Equity Plan or Community Health Improvement Plan (thereby interlinking with community input processes)
  • Dedicated portions must go to health equity and behavioral health

The effort was driven by health equity advocates, Community Advisory Councils, and provider groups who came together to make a strong case before the House Committee on Health Care. There is no guarantee the federal government will approve the proposal, but the bipartisan backing of the legislature gives Oregon a stronger bargaining position. The initiative also ties in with the Biden Administration’s goals of building upon the Affordable Care Act and reducing health disparities.

Providing Health Coverage to Undocumented Adults

The major focus on equity and racial justice this session extended deeply into health care policies. The legislature approved $100 million to expand the Cover All Kids program to provide Medicaid-like coverage to undocumented adults. As the need will likely outstrip available funds in this phase, the OHA is charged with allocating benefits.

Dan Cushing testified on behalf of COHO in support of HB 3352 and said when parents are healthy, kids get healthier too. COHO participated in weekly coalition meetings, lobbied in support of the bill, and promoted the bill on its social media channels.

Improving the CCO Contracting Process

COHO moved forward on one of its biggest priorities by securing a budget note on the OHA budget relating to CCO contracts:

The Oregon Health Authority shall report to the Legislature on its plans for the next round of coordinated care organization contracting. The report shall include: 1) anticipated milestones and deadline dates; 2) an outline of how the process will provide public transparency and communication; and 3) the anticipated resources the agency will need to perform the next round of CCO contracting. The report shall be delivered to the Joint Committee on Ways and Means by January 1, 2023.

This gives legislators and the public an opportunity to collaborate with OHA and prevent some of the problems that emerged in the CCO 2.0 procurement process of 2019. This will go hand in hand with the Secretary of State’s Audit Plan to ensure responsible use of funds and maximizing federal matching dollars for Oregon’s Medicaid program.

Looking Ahead

Unfinished business from the session includes securing a technical fix on a new demographic data collection bill, enacting legislation to provide transparency on the cost of health care administration, and clarifying in law that CCOs may continue to manage local drug formularies.

Throughout the interim and next legislative session, COHO will continue to advocate strongly for policies that advance health equity and transformation. We offer our support to the Executive Branch and the Legislative Assembly; if we can be of assistance, please do not hesitate to reach out.

CORVALLIS, Oregon – Coalition for a Healthy Oregon (COHO) is pleased to announce that
InterCommunity Health Network (IHN-CCO) has joined its statewide association of coordinated
care organizations (CCOs). COHO members are CCOs that connect members to physical,
behavioral, and dental care in communities across the state. CCOs provide high-quality, locally
controlled health care and wellness services to people who qualify for Medicaid due to low
income or disability.

COHO’s seven CCOs serve more than 282,000 Oregonians, amounting to 39% of CCO members
outside Multnomah, Washington, and Clackamas counties. IHN-CCO serves more than 71,000
Oregonians in Benton, Lincoln, and Linn counties.

“We are pleased to welcome InterCommunity Health Network CCO to the COHO family,” said
Doug Flow, COHO president. “We will all benefit from their unique perspectives and ideas.”
COHO members have been top performers in health quality metrics, which improve population
health while saving taxpayer dollars.

“InterCommunity Health Network shares COHO’s values of advocating for members, fully
funding Medicaid, and maintaining local control,” said CEO Bruce Butler. “COHO is a thought
leader in Medicaid policy, and we will collaboratively continue the hard work of transforming
health care for the benefit of our members.”

IHN-CCO was formed in 2012 by local public, private, and non-profit partners to unify health
services and systems for Oregon Health Plan (Medicaid) members in Benton, Lincoln, and Linn
Counties. IHN-CCO is committed to improving the health of their communities while lowering or
containing the cost of care, coordinating health initiatives, seeking efficiencies through blending
of services and infrastructure, and engaging all stakeholders to increase the quality, reliability,
and availability of care.

COHO has played a key role in the continued evolution of the Oregon Health Plan and health
care policy in Oregon since it was founded in 2005. With the support of its members, COHO is
known for bringing innovative ideas to Oregon health policy.

In the current legislative session, COHO has worked with legislators to advance House Bill 3353,
which asks the federal government for greater flexibility and matching dollars for provider
reimbursement and investments in the social determinants of health. When Oregon faced a
budget crisis due to the COVID-19 recession, COHO was instrumental in providing to state
budget leaders a pathway to maintain Medicaid funding.

About COHO

COHO’s members include Advanced Health (serving Coos and Curry Counties), AllCare Health
(serving Josephine, Jackson, and Curry Counties and parts of Douglas County), Cascade Health
Alliance (serving Klamath County), Trillium Community Health Plan (serving Lane County and
parts of Linn and Douglas Counties), Umpqua Health Alliance (serving Douglas County), Yamhill
Community Care Organization (serving Yamhill County and parts of Washington and Polk
Counties), and InterCommunity Health Network (serving Linn, Benton, and Lincoln counties).
COHO and its partners have helped expand the number of individuals who qualify for the
Oregon Health Plan, promoted primary and preventive care, strengthened wraparound
services, and secured stable health care funding through the passage of provider assessments
and Ballot Measure 101.

CCOs make community investments that address Social Determinants of Health (SDOH) and Health Equity. The OHA then looks at those SDOH related community investments and decides what specific investments qualify for Health Related Services (HRS). Historically, some of these investments are not accepted as HRS, but rather, “administrative expenses,” and thus, these are not captured in the rate of growth for future rate setting cycles. This erodes CCOs’ ability in forward years to sustainably fund community programs. Some of these decisions are tied to what CMS defines as HRS, meaning this is more than just an issue at the state level.

HB 3353 requires the OHA to include in its 1115 Waiver renewal request:

  • Up to 3% of CCOs’ budgets can be counted as medical spend if they are: investments improving health equity, community-based SDOH programs, or improve the overall health of the community; or enhanced payments to providers who can demonstrate that they can address the culturally and linguistically appropriate services needed in their community, or that the increased funding can improve services to the community as a whole.
  • To ensure the equitable distribution or redistribution of resources and power, at least 30% of these funds will be dedicated to further the goals of the CCOs Health Equity Plan and Community Health Improvement Plan as approved by the Community Advisory Councils.
  • At least 20% of these funds will be used to address needs in Behavioral Health.
  • Create an oversight committee (modeled on the Metrics and Scoring Committee) within the OHA Office of Equity and Inclusion to review the outcomes of all investments in Health Equity, SDOH, and provider investments. This Committee would be charged with recommending best practices and writing the criteria for investments that qualify for this (which would also have to be approved by CMS).
  • Change these funds to be considered medical spending, which will create sustainable funding for programs year over year.

During the COVID-19 public health emergency, COHO CCOs have continued to invest in their communities to improve access to health care services. One such investment serving thousands of Oregon Health Plan (OHP) members is the Trillium Resource Exchange, or T-REX for short.

This investment, made by Trillium Community Health Plan helps connect OHP members to nearby resources they need, like local food banks, housing and utility resources, and more. It’s translated into over 100 languages to help ensure language is not a barrier to accessing care.

This investment is not only available for OHP members. Traditional health care workers, providers, and others who work regularly with OHP members can access this database in order to provide extra support.

T-REX is a user-friendly program that allows health care providers, care teams, and non-profit services providers to send and receive referrals and update the status of referrals easily and efficiently. T-REX also connects to electronic health records so providers are able to seamlessly manage their patients’ care.

Why are investments like these important to Oregon’s health care system?

Investments like these address Social Determinants of Health and Equity (SDoH-E). Other examples of SDoH-E investments include funding food banks, shelters, interpreters, and more. These evidence-based investments help decrease health inequities and keep OHP members healthier.

Our CCOs have shown evidence-based SDoH-E play a significant role in a person’s health, in turn reducing the cost of health care for Oregon. We know that when individuals have food and housing security, they are more likely to be healthy. This focus on preventive services results in fewer ER visits and other more expensive health services – saving the state money. For these reasons, CCOs spend millions of dollars each year investing in specific supports that their individual communities need. Programs like T-REX make sure this network of resources is readily available to our most vulnerable communities.

Nurturing Investment

If our goal is to ensure Oregonians remain healthy, we need to create stable funding streams for initiatives that fit each of their communities’ unique needs. We are doing a disservice to Oregonians working to rise out of generational poverty, trauma, and poor health if the programs they rely on only exist in sporadic timelines.

We are working to identify sustained funding streams for programs with proven long-term health outcomes. Investing in overall health is long game, and our CCOs are intent on keeping these programs in place.

About COHO

COHO is a coalition of six locally-based coordinated care organizations charged by the legislature to deliver care to Oregon Health Plan (OHP) members. COHO CCOs serve just over 184,000 OHP members or approximately 16% of the statewide membership.

In the face of a pandemic, the Coalition for a Healthy Oregon’s coordinated care organizations (CCOs) have been stepping up to ensure their members receive the care they need promptly and effectively

Earlier this month, the Roseburg News-Review ran a story about a toddler, Jameson Wilson, who has a chronic condition called eosinophilic esophagitis. This condition causes an allergic reaction in the esophagus and was preventing Jameson from being able to eat, as well as causing him to break out in eczema rashes. The boy’s parents tried to switch his formula and consult his doctors, but his symptoms persisted, and he was unable to keep food down.

Finally, Jameson’s mother decided to switch his care to Tasha Rutledge, a nurse practitioner at Umpqua Health-Newton Creek, a health clinic operated by COHO member Umpqua Health Alliance and offers expert pediatric and adult primary care in Douglas County. Care for Jameson was immediately approved, and Jameson was put on a treatment plan that centered around eliminating foods and most formulas.

This was a large financial burden for Jameson’s parents, until the Women, Infants, and Children (WIC) program helped to cover the costs. However, since Jameson would potentially have this condition for the rest of his life, long-term solutions were necessary. Rutledge also approved for Jameson to have a gastronomy tube surgically inserted into his abdomen to deliver nutrition directly into his stomach.

Because CCOs are able to tailor delivery of care to the specific needs of their community, they are able to act quickly and provide the right care at the right time. Oregon has one of the most advanced Medicaid delivery systems in the nation, and this success story is one of the many examples that show the high-quality and effective care that COHO CCOs deliver across our state.

To read all about Jameson’s journey of receiving his gastronomy tube during COVID-19, you can read the full article here.

Partnership Builds Momentum for COHO’s Aggressive Legislative Agenda

MCMINNVILLE, Oregon – The Coalition for a Healthy Oregon (COHO) is pleased to announce that Yamhill Community Care has joined its statewide association of coordinated care organizations that now represent more than 184,000 members of the Oregon Health Plan.

The six members of COHO provide high-quality health care and wellness services to people who qualify for Medicaid due to low income or disability.

“Yamhill CCO shares COHO’s values, which include a commitment to local, patient-centered care and innovation to improve population health,” said Doug Flow, COHO President. “The resources and perspectives brought by the hardworking professionals of Yamhill CCO will better position COHO for success in its 2021 legislative agenda and beyond.”

While presenting myriad challenges to the health care system, the coronavirus pandemic showed the strengths of Oregon’s local coordinated care model. With boots on the ground and strong relationships in every community, CCOs throughout Oregon were well positioned to provide immediate assistance to Medicaid recipients, participating providers, and county public health departments. However, the crisis has led to a steep decline in state revenues, which could jeopardize the viability of the system, particularly in rural areas. CCOs have been a critical lifeline for them private health care providers Oregonians rely on.

“COHO is Oregon’s most effective organization for CCO policy development and health systems innovation,” said Dr. Seamus McCarthy, CEO of Yamhill CCO. “We look forward to engaging strongly in the legislative process as a member of COHO and will benefit from its expert communications and top-tier governmental advocacy.”

COHO members provide health services that center and prioritize the patient-provider relationship. They have been top performers statewide in quality health metrics and keeping people out of high-cost care, such as emergency departments. The effect has been to save taxpayer dollars while improving population health, in line with Oregon’s Triple Aim for better health, better care, and lower costs.

Long before the recent focus on health equity, COHO has been a leader in addressing health disparities in underrepresented communities. By investing in the Social Determinants of Health and Health Equity, COHO has worked to break down barriers to health through strategic investments and innovative policy development. This means addressing health factors like food, housing, education, and transportation to produce greater health outcomes for the most vulnerable members of our society.

In Oregon, about 23.8 percent of our population uses the Oregon Health Plan (OHP) for their health insurance. That means CCOs across the state are serving roughly 984,106 Oregonians by ensuring they have access to equitable, timely, and appropriate health services. This current organization that utilizes CCOs as a single point of contact for Medicaid health services is not always what OHP looked like.

In 2012, our state was at a breaking point. If we did not change the way we ran our Medicaid delivery service, we were looking at taking a 33 percent cut in reimbursement rates to providers. Because the Medicaid reimbursement rate is already much lower than other health insurance companies offer, this cut would have decimated the Oregon Health Plan. Health care providers across the state would have been unable to see Oregonians on OHP because the rate would not have covered the cost of the visit to the provider.

Not only were we looking down the barrel of a giant cut in reimbursement rates, the system that we had was not working for OHP members, either. Instead of OHP being a single over-arching health plan that included physical health, mental health, and dental health, it was broken into three different plans. These plans did not communicate among themselves, making it incredibly difficult for OHP members to understand how their Medicaid coverage worked, and how to effectively navigate the system.

Former Governor Kitzhaber, as well as several legislators, lobbyists, and other elected officials, stepped in to address not only the budgetary issue, but the concern that Oregonians were not receiving the care they needed due to systemic problems. To address the concern that Oregonians could not navigate the current Medicaid system, Governor Kitzhaber recommended the state create a single point of contact for physical, mental health, and dental services that works to organize not only OHP members, but providers as well. He thought that by coordinating the care that OHP members were receiving, we could increase our efficiency and decrease the cost.

Dr. Bruce Goldberg, the Director of the Oregon Health Authority at the time, was also at the forefront of the state’s push to re-organize our Medicaid system. Dr. Goldberg believed that we could make OHP easier to navigate, save the state dollars on health care, and push for incentives that create better health outcomes for Oregonians.

So, Governor Kitzhaber, Dr. Bruce Goldberg, Rep. Tina Kotek, Rep. Tim Freeman, and Sen. Alan Bates worked with lobbyists including Paul Phillips and Josh Balloch to create a new Medicaid program that would serve Oregonians, save our Medicaid program, push for better outcomes, and save the state money. Their ideas were groundbreaking and included concepts like utilizing a global budget for CCOs, creating incentive programs to increase positive health outcomes for Oregonians, and setting rate of growth allowances to lower than the national average.

Every piece of this legislation was important. Global budgets ensure that the CCO, instead of the state, takes on the risk of paying out reimbursements for members. Incentives for CCOs to increase positive health outcomes push CCOs to continue transforming health care in new and creative ways, like including social determinants of health spending on food security, housing security, etc. Finally, setting the CCO’s rate of growth allowance 2% below the national average could save $2 billion dollars over four years.

Not everyone was a fan of the new plan for Medicaid. Powerful status quo providers were not interested in changing the way OHP was structured, and there were several other competing pieces of legislation. On top of that, the House was evenly split between 30 Republicans and 30 Democrats and headed by two co-speakers, making the job of these public officials and lobbyists even harder. Fortunately, this legislation passed off the Senate floor with 18 votes, and off the House floor with 53 votes. This was only possible because of the hard work of the many advocating for this change, and the bi-partisan understanding that Oregonians need access to quality health care.

The final step was securing federal funds to jump start the program. Gov. Kitzhaber and Director Goldberg flew to the White House to meet with President Obama. They shared our state’s revolutionary ideas for Medicaid delivery, and requested $1.9 billion dollars in Federal funds to start the program. They shared with the President that they planned to cap the CCOs at 2% below the national average rate of growth in health care so that they could save the Federal government $2 billion dollars within four years, effectively paying back the state-up money. President Obama approved the funding request whole-heartedly, and the Oregon Health Plan was reborn.

The legislation that they dreamt up in 2012 is still in effect today, ensuring that Oregonians get the care they need, the state saves money, and that we continue to push for health transformation that stays true to the original member-centered, locally-controlled CCO model.
Thank you, Governor Kitzhaber, Dr. Goldberg, Rep. Kotek, Commissioner Freeman, the late Sen. Bates, COHO lobbyists and members who helped conceive and pass this legislation, and the countless others who were involved in fighting for the Medicaid delivery system we have today!