With potential new legislation on the horizon in 2025, Coalition for a Healthy Oregon (COHO) hosted a roundtable on April 23 with state lawmakers and former Gov. John Kitzhaber to discuss improvements to the state’s coordinated care model and ensure organizations will continue to meet health care needs in their communities.

Seamus McCarthy, CEO of Yamhill Community Care, one of seven coordinated care organizations (CCOs) that make up COHO, introduced the meeting and highlighted major achievements since Oregon transformed its Medicaid program in 2012. These include:

  • Covering more than 1.4 million Oregonians, or 1 out of every 3 residents statewide.
  • Lowering the rate of cost growth to 3.4%, two percentage points below medical inflation of 5.4%.
  • Saving state and federal governments more than $6 billion.
  • Investing more than $271 million in social determinants of health between 2020-22.

The roundtable was meant to identify challenges and solutions for Oregon’s community-based CCOs, such as the need for more flexible spending, creating long-term contractual stability, and better addressing behavioral health, housing, and homelessness services.

Reassessing the vision

Kitzhaber, who as governor oversaw the creation of the coordinated care model in 2012, called for a reassessment of its vision to “ensure it aligns with evolving health care goals.” He suggested a framework for future discussions that “prioritizes community-focused health care with a single point of accountability.”

A central question for CCOs, Kitzhaber said, is how to balance flexibility for organizations trying to meet their communities’ unique health care needs with the equally important need for proper oversight and accountability.

Greater flexibility

CCO leaders called for greater flexibility in spending to address their local health care needs, without being limited strictly to medical services with billing codes. Doing so, they said, would allow for more investments in programs that benefit health equity and health outcomes outside of clinic walls — things like emergency shelters, housing, and street outreach for vulnerable groups.

The discussion delved deeper into the importance of these “social determinants of health,” and the role CCOs should play working with community partners. One of the questions posed by Kitzhaber was focused on creating an environment that “encourages, incentivizes, and rewards stable local relationships and long-term community upstream investments in social determinants of health,” and what that might look like in the next CCO contract procurement.

Behavioral health, housing, and homelessness

There was a strong call for more investments in behavioral health resources to improve overall health outcomes. Ideas included potentially offering scholarships, leveraging federal funds, and partnering with local schools to boost the behavioral health workforce.

Housing and homelessness were also acknowledged as having a severe impact on health. In order to address this, a task force convened by leaders representing CCOs, counties, and other health systems partners will focus on coordinating health services with housing and homelessness initiatives.

Contract Stability

Roundtable participants agreed that longer contracts for CCOs are a way to create more long-term stability and sustained investments. There was broad agreement among the group that five years between procurement is too short, and CCOs need more time to forge lasting partnerships with care providers and address their communities’ most pressing health needs. One suggestion called for a contract term of 10 years, with a mid-term review to maintain accountability.

Amid potential reforms, the participants agreed to continue collaborating. They also announced the rollout of a CCO work group, spearheaded by Rep. Rob Nosse (D-Portland) and supported by legislative staff, that will work to address key health policy issues ahead of the 2025 legislative session.

CCOs support housing development, programs for unhoused

A comprehensive report on rural homelessness published by AllCare Health in February highlights the challenges meeting short-term and long-term needs of the unhoused population.

“Finding Home: A True Story of Life Outside” was developed by Julie Akins, Senior Housing Director at AllCare Health, through hundreds of interviews with unhoused people in Josephine, Curry and Jackson counties and research on the root causes exacerbating the crisis.

The report shows some startlingly statistics about homelessness:

  • Between 2020 and 2022 the number of people experiencing homelessness in Oregon rose by 23% or 3,304 people, to more than 18,000, according to the federally mandated point-in-time count.
  • 46% of unhoused persons cited unemployment, low income, and economic reasons such as high rents for their condition of being unhoused. The National Coalition for the Homeless cites: “46 to 60% of unhoused people float in and out of full or part-time work.”
  • Key factors in homelessness remain a reduced housing stock, notably in households earning at or below the average median income, according to EcoNorthwest.
  • The Oregon Department of Education (ODE) reports almost 22,000 children in the 2017-18 school year qualified as homeless students under the ODE definition as they lack a “fixed, regular, or adequate nighttime residence.”

The report has been covered extensively in the media, including the Oregon Capital Chronicle, High Country News, KOBI-TV, and Jefferson Public Radio.

A lack of available and affordable housing is a major factor, especially in rural counties, and AllCare Health is advocating for relaxed zoning restrictions in small communities to allow new housing development.

The Oregon Legislature has approved $576 million the past two sessions to address the housing crisis, but while houses are being built there is a continued need for resources like drop-in services and short-term shelters.

Coordinated Care Organizations are committed to supporting these local services as they advocate for long-term housing solutions.

The annual Oregon State of Reform Health Policy Conference took place at the Hilton Hotel in Downtown Portland on November 14, 2023. The opening session centered on Coordinated Care Organizations, featuring speakers like Seamus McCarthy, CEO of Yamhill Community Care, and Mindy Stadlander, CEO of Health Share of Oregon.

During the legislative panel, Rep. Rob Nosse (D-Portland), Rep. Ed Diehl (R-Stayton) and Thuy Tran (D-Portland) from the Behavioral Health & Healthcare Committee, had a wide-ranging discussion of healthcare policy priorities moderated by Dan Cushing, government affairs director at Yamhill Community Care. Topics included a comprehensive CCO workgroup slated for 2025 and Ballot Measure 110.

2025 CCO Workgroup

During the 2023 Legislative Session, Rep. Nosse began talking about pulling together a comprehensive workgroup in the lead up to and during the 2025 legislative session to discuss the CCO model in Oregon. Prior to the State of Reform panel, the precise focus on this workgroup’s discussion remained vague, despite coming up fairly often in public discussions.

During the panel discussion, Rep. Nosse outlined the following priorities for the workgroup:

  • Outcomes for CCO members and their communities;
  • The regulatory framework that CCOs operate within;
  • CCO finances, with a focus on provider assessments and the medical loss ratio; and
  • The duration of CCO contracts after the next procurement.

With this framework now public, it will be easier to tailor COHO’s activities over the course of the next 18 months to dovetail with these future conversations.

Ballot Measure 110

Reforms to the Drug Addiction, Treatment and Recovery Act (Measure 110) passed by Oregon voters in November of 2020 have been front of mind for anyone having serious discussions about health policy in Oregon. “I think most of you know we are struggling with the rollout and implementation of ballot Measure 110,” Rep. Nosse said during the panel discussion.

Rep. Diehl echoed concerns brought forward by individuals who believe that decriminalization efforts have gone too far and have resulted in unintended consequences. “I think one element of it has to be re-criminalization of possession — not to throw people in jail, but to give some incentive to pursue treatment,” he said.

Some of Rep. Tran’s comments focused upon the behavioral health workforce shortage, which has been simmering for decades. The solutions to this vexing issue need to be home grown. Put succinctly, by Rep. Tran, “it’s just not going to magically appear.”

The COHO government affairs team will be working with their medical and behavioral health directors to establish some nonpolitical guideposts for this reform effort, which will be shared with policy makers early next year.

Coordinated Care Organization employed GIS mapping to identify members impacted by wildfire and connect with community resources

In September of 2020, the Almeda Fire tore through the Rogue Valley in Southern Oregon, destroying more than 2,600 homes and creating a health crisis for thousands more – including many members of the Oregon Health Plan. Because of its detailed knowledge of local members and its connections to community resources, AllCare Health was able to quickly deploy help to at-risk residents.

This article from the New England Journal of Medicine Catalyst (November 2022) highlights how AllCare Health, one of COHO’s members, put the promise of the CCO model into practice during the emergency:

Within hours of the fires igniting locally, AllCare Health staff began the planning process for responding to members’ needs. The following day, AllCare deployed ArcGIS (Esri, Redlands, CA), a software tool that brings together geographic information systems (GIS), mapping, and analysis, to identify our members who were living within the fire zones. The tool relies on existing addresses for our members and readily identified those at risk, enabling prompt action during the crisis.

Using internal identification keys, we were then able to initially identify more than 8,300 affected Medicaid and Medicare members, including approximately 700 elderly, 700 disabled, and 51 expectant mothers. AllCare’s IT staff then forwarded the names of affected individuals to other internal staff, who began calling those members to inquire about their well-being and needs. A total of 9,630 affected members were eventually identified.

Read the full article at New England Journal of Medicine Catalyst by Dr. Richard Williams, MD, MBA, FAAFP.

Douglas County’s Coordinated Care Organization used patient analytics to find at-risk members for proactive outreach

Local care delivery is about more than physical, behavioral, and oral health care. Coordinated care organizations are investing heavily in the social determinants of health (SDoH) to improve health outcomes and achieve health equity.

This article from Healthcare Business Today highlights how one of COHO’s members, Umpqua Health Alliance, is addressing local needs through data and flexible investments:

Earlier this year, Umpqua Health obtained funding that allowed it to obtain 420 air purifiers to proactively distribute prior to the 2022 fire season, but first health system leadership needed to determine which patients had the greatest need for the devices. Umpqua Health used its analytics platform to pinpoint the patients most at-risk for respiratory complications by running a model that predicts an individual’s future risk based on past events and claims data.

The health system then contacted those members via text message to gauge their interest, and then began distributing the purifiers to patients through its transitional care clinics, in addition to home deliveries for homebound patients. So far, 76% of patients contacted have accepted the offer of the air purifiers, and Umpqua Health has distributed 309 of its 420 total allotment.

Read the full article at Health Care Business Today by Dr. Rich Parker, MD, the Chief Medical Officer at Arcadia.

Oregon should protect and enhance the local coordinated care to ensure communities get the most bang-for-buck toward health and health equity.

Coordinated Care Organization commits to covering funding shortfalls to keep critical service running in rural Oregon

The Behavioral Health Unit at Bay Area Hospital will remain open thanks to funding support from COHO member Advanced Health and other community organizations. The support led to the reversal of an earlier announcement that the unit would face imminent closure due to lack of funding. This story illustrates the important role coordinated care organizations (CCOs) play in their local communities.

Read the June 14 press release: “Community Joins Forces to Keep Behavioral Health Unit Open at Bay Area Hospital.” via Bay Area Hospital.

Oregon’s coordinated care model allows local CCOs the flexibility to meet local health needs through partnerships and investments in health infrastructure.

“Advanced Health is pleased to support this important work,” said CEO Ben Messner. “CCOs are the glue that holds the health system together and prevents people falling through the cracks, particularly in rural Oregon.”

During the pandemic and through natural disasters, CCOs across the state stepped up to help members, providers, and other partners with a range of needs, including behavioral health care. Such actions demonstrate the importance of local control, budget flexibility, and breaking down siloes through strong partnerships.

Advanced Health serves more than 25,000 members of the Oregon Health Plan (Medicaid) in Coos and Curry counties. Its network includes physician clinics, hospitals, county providers, substance abuse, and dental services.

COHO is an association of seven CCOs across Oregon. It advocates for local control, health equity, and preserving the coordinated care model.