CareOregon Health Plans Achieve NCQA Accreditation

February 28, 2012 -- The National Committee on Quality Assurance (NCQA) has awarded Commendable accreditation to CareOregon Health Plan and CareOregon Advantage Plus Medicare Advantage plan.

CareOregon is the largest Medicaid MCO in Oregon, managing care for nearly 160,000 Oregon Health Plan (OHP) members, about a quarter of the OHP membership. CareOregon Advantage Plus HMO-POS is a special needs plan, coordinating care for about 6,000 members who are eligible for both Medicare and Medicaid.

“We’re very pleased to earn NCQA Commendable accreditation,” said Margaret Rowland, MD, CareOregon Chief Medical Officer. “Accreditation is a validation of the work we have been doing at CareOregon to provide better care for Oregonians, regardless of their social circumstances.”

CareOregon Health Plan is the first Medicaid plan in Oregon to receive NCQA accreditation. The CareOregon Advantage plan is one of five accredited Medicare plans in the state. There are three levels of accreditation: Accredited, Commendable and Excellent, the highest level.

“Achieving an accreditation status of Commendable from NCQA is a sign that a health plan is serious about quality,” says Margaret E. O’Kane, NCQA president. “It is awarded to plans whose service and clinical quality meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement.”

Accreditation follows a voluntary process of evaluating quality of care and customer service. NCQA accreditation is more comprehensive and specific than other health plan accreditations because NCQA verifies scores and publicly reports results in five categories:

  • Access and Service—Do health plan members have access to the care and service they need?
  • Qualified Providers—Does the health plan assess each doctor’s qualifications and what PPO plan members say about its providers?
  • Staying Healthy—Does the health plan offer activities to help members maintain good health and detect illness early?
  • Getting Better—Does the health plan offer programs and activities for members to help them recover from an illness?
  • Living with Illness—Does the health plan care offer programs and activities for members with chronic conditions to help them manage their chronic illness?

Gaining NCQA accreditation and keeping it requires continuous improvement and better value per health care dollar.

“The application process helped formalize the quality improvement process we already had in place,” Dr. Rowland said. “And that helps us continue our efforts to transform health care and make it more affordable, produce better outcomes and be a better experience for our members.”

The accreditation process evaluates how well the health plan manages all parts of its delivery system—physicians, hospitals, other providers and administrative services.

The years-long process includes rigorous, on-site and off-site evaluations, using information from health plan records, consumer surveys, interviews with plan staff and performance on selected HEDIS® and CAHPS® measures.

         HEDIS—the Healthcare Effectiveness Data and Information Set—is a registered trademark of the National Committee for Quality Assurance. HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service, including preventive care, chronic care management measures and treatment outcomes.

         CAHPS—the Consumer Assessment of Healthcare Providers and Systems—is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). CAHPS Health Plan Survey is the national standard for measuring and reporting on the experiences of consumers with their health plans.

An NCQA team of physicians and health plan experts conducts the accreditation surveys, which are analyzed by a national oversight committee of physicians. The oversight committee assigns an accreditation level based on the performance level of each plan being evaluated.

CareOregon’s Commendable accreditation must be renewed in three years.

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Very well deserved - Congratulations CareOregon! This is great news for our state. PR

well deserved? CareOregon has been pilfering OHP money to build up its "reserves" for years now while the rest of the state suffers. doesnt sound like a high quality organization to me. It's sad , that with this whole cco deal passing the legislature that it is only a matter of months before careoregon takes on mental health services as well, likely leading to the demise of the other plans in the metro area. what will this mean? it will mean careoregon will increase its capitation and its massive, massive, chest of gold. Where's the oversight and accountability? I am on OHP, and my family is on OHP, and it keeps me awake at night to know that come july 1, careoregon will limit access to care for all of our medical and mental health benefits so that Dave Ford can expand his tentacles further into the limited resources of oregon welfare. These are of course, my thoughts and opinions on the matter. Below are the facts : Fact: CareOregon currently has over 200 million dollars of cash in reserve. Fact: CareOregon's CEO is not an Oregonian.. Yet he runs a company charged with administrating medical benefits to our fellow oregonians. Fact: CareOregon's opulant office downtown is a shameless reminder to us all, that we are being hoodwinked. Fact: CareOregon has driven this CCO process from the beginning with it's own interests in mind. Fact: Bruce Goldberg, John Kitzhabers Medical Czar- was the original medical director at careoregon. Fact: CareOregon has conitunally cut its payment rates to hospitals over the past 10years even as its surplus has flourished. Fact: CareOregon's financial records are available to any concerned citizen through the state. just call dmap. Time is ticking folks.

My experience with CareOregon's chronic patient support and care is not good. They deny specialist appointments for as long as possible. They make every effort difficult and often reject a request from a physician until the patient goes through appeal after appeal. Instead of working hard to get a patient well, they prolong the problem by trying to save money--thus the suffering of the patient lasts longer and the effectiveness of the patients physicians care is inhibited. I'm sorry, but what survey of patients provided the information for this award?