CCO’s keep up their balancing act

Latest OHA report on key performance metrics says that growth in spending remains in check as Medicaid rolls climb to nearly 1 million across Oregon. Toughest problems still hard to change.

Oregon’s coordinated care organizations continue to manage a delicate balance: keeping costs down at the same time they are providing coverage to more and more Medicaid patients as a result of the Affordable Care Act.

That’s the finding of a report on the state’s health system transformation released Wednesday by the Oregon Health Authority’s Office of Health Analytics. It evaluated the progress achieved by coordinated care organizations on key quality and financial measures between July 1, 2013 and June 30, 2014.

Emergency department visits are down. So are hospital admissions from chronic diseases. More and more people are enrolled in patient-centered primary care homes, which aren’t really homes at all, but clinics designed to improve coordinated care.

Even the bottom line is looking up. As more healthcare services are provided within primary care rather than at more costly settings such as the emergency room, for example, the system is saving money. The state is making good on its promise to the federal government to reduce the growth in Medicaid and Medicare spending by 2 percentage points per member, per year.

“Overall it reflects a positive moment. The coordinated care organizations and OHA should be proud of what’s been accomplished in a short period of time,” said Cynthia Ackerman, vice president of community engagement and government programs for Mid-Rogue Independent Physician Association and its AllCare Health Plan.

The report’s results are substantiated by the internal numbers Ackerman sees at AllCare, which covers more than 50,000 members in four counties in southern Oregon.

Not everyone shared her enthusiasm, however.

“Overall, the numbers are pretty encouraging, but not particularly newsworthy,” according to Dr. Robert Dannenhoffer, CEO of Umpqua Health Alliance and Architrave Health in Roseburg, who sent an email to The Lund Report.

Jeff Heatherington, president and CEO of FamilyCare Health Plans in Portland, went a little further. “As usual the OHA has managed to put out something that doesn’t have a lot of meaning in terms of where we are going.

“The system has worked well. The trouble is, I think the report generally shows that we’re being successful but the numbers aren’t as factual as they could be. I wouldn’t bet the rent on them, put it that way,” he said.

On that point, Dannenhoffer agrees. “I trust the numbers, but would caution anyone in putting too much stock in a change over six months.”

One number not in dispute is the number of new patients receiving coverage. The Medicaid rolls in Oregon skyrocketed more than 60% last year as the state added 380,000 people to the Oregon Health Plan as a result of expanded coverage through the Affordable Care Act. Approximately 990,000 Oregonians are enrolled today.

Who are these new patients? The racial and ethnic makeup hasn’t changed much, but the proportion of members aged 19-35 enrolled in Medicaid has increased more than other age groups. Individuals 35 and under now account for 68% of all state residents receiving Medicaid.

These newly enrolled Oregon Health Plan members use emergency rooms 33% less frequently than those currently enrolled and also have lower rates of avoidable emergency room visits than other members.

Now, for more details on costs from the report. For inpatient hospital services, per member per month costs have decreased 5.7% since 2011, the baseline year. “This indicates utilization did not increase as more members enrolled in Medicaid and the inpatient dollars were spread to a larger population. The greatest cost declines were in mental health inpatient and maternity categories, dropping 12.7% and 11.1% from 2011, respectively,” the report said.

Outpatient costs have decreased 4% since 2011, but rose slightly compared to a year ago, to $183.71 per member, per month. Costs are calculated by dividing the total claims paid by the total member months and are categorized by major services.

Outpatient costs actually increased for two subcategories: primary care and prescription drugs. “With the inception of CCOs, a key focus has been to increase resources at the primary care level to ensure that patients are accessing care and treatment plans are initiated in a way that is effective for the patient,” the report said. It found that emergency department costs decreased from 2011 by 20% in the second quarter of 2014.

Two areas that needed improvement in the previous performance report are proving difficult to turn around. Last June, in its 2013 performance report, the OHA said that screening for risky drug or alcohol behavior and providing adequate access to healthcare providers would receive greater focus in the year to come.

The latest report found that alcohol and substance abuse screening is improving but is still below the benchmark. Statewide, adolescent well-care visits have remained fairly steady, but still fall far below the benchmark, and childhood and adolescent access to primary care providers continues to decline slightly.

“This set of metrics is an area with an opportunity for improvement since access to primary care providers has declined across all age categories,” the report said. “In particular, the youngest children experienced the greatest decline perhaps due to the new Affordable Care Act members not yet having a primary care visit. In June 2014, there has not been improvement on these measures when compared to 2011 or 2013. Hispanic/Latino members experienced the greatest decline in access between 2013 and June 2014.”

Christopher can be reached at [email protected].

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