There’s huge variation in what Oregon’s coordinated care organizations are paying to take care of their members, according to financial reports that provide a first glimpse of how these CCOs performed in the three months that all state residents were required to carry insurance.
At the low-end of spending is Yamhill Community Care, which spent $242 per member each month on medical services from January through March this year. At the other extreme, Western Oregon Advanced Health spent $412 per member per month.
The quick financial snapshots filed by 16 CCOs don’t delve into the reasons for these Medicaid-funded insurance-like plans’ results, and Alissa Robbins with the Oregon Health Authority said they provide relatively little new information. “These are part of the contractual requirements for CCOs,” she said. “They have to file them.”
But the snapshots do provide some insight into the financial health of these organizations, which collectively reported $794.45 million in first-quarter operating revenue and which had $598.1 million in assets as of March 31. These health plans serve more than 860,000 Oregonians statewide.
All but one of the 16 CCOs that filed financial reports with the Oregon Health Policy Board were profitable in the first quarter, with Trillium Community Health Plan the only of these companies to report a net loss. Trillium says its net loss was $504,237 – though with $85.3 million in assets, that slim loss should not threaten its financial health. Unlike most CCOs in Oregon, Trillium offers more than just coordinated care for the low-income. It sells Medicare Advantage health plans for older Oregonians, and also sells some individual health plans. Because it offers these other lines of insurance business, Trillium submitted financial details in a different format than the state’s other CCOs, and did not break out how much it spends per member each month.
The costs at the CCO that spends the most per member likely reflect the challenges of its geographic and health-care environment. Western Oregon Advanced Health is the only CCO providing Medicaid-funded coverage to some 20,000 people in Coos and Curry counties – a region with more hospitals serving its population base than perhaps any other rural area in the state.
Western Oregon Advanced Health, or WOAH, is trying to increase quality, expand access, and, yes, also reduce its expenses, President Phil Greenhill said in an interview in mid-July. “The difficulty has to do with the design of the system as it exists today. It’s not completely compatible with that vision.”
In some portions of its coverage area, WOAH’s members are within a fairly short drive of three hospitals – and some of those hospitals are legally allowed to charge more than others, under state and federal rules aimed at protecting the financial stability of rural health operations. Changes coming to how many of Oregon’s rural hospitals are compensated for Medicaid care may reduce the costs that WOAH is currently facing.
Here’s how much each of Oregon’s CCOs reported spending each month on average medical expenses per member:
- Western Oregon Advanced Health: $412.
- IHN-CCO: $343.
- Umpqua Health Alliance: $340.
- PacificSource-Columbia Gorge: $330.
- Jackson Care Connect: $330.
- Health Share of Oregon CCO: $314.
- Eastern Oregon CCO: $311.
- PacificSource-Central Oregon: $310.
- Columbia Pacific CCO: $306.
- Family Care Inc. $299.
- Willamette Valley Community Health: $269.
- PrimaryHealth of Josephine County: $265.
- AllCare Health Plan: $253
- Cascade Health Alliance: $252.
- Yamhill Community Care Organization: $242.
- Trillium Community Health Plan: Did not break out per-member monthly cost.
Click the accompanying spreadsheet for a quick summary of other major financial details reported by these CCOs.
Courtney Sherwood can be reached at [email protected]. Follow her on Twitter at @csherwood.
