Most of Oregon’s coordinated care organizations are profitable, with only three of 16 posting net losses in the first three months of 2016, according to a Lund Report review of financial records. And those that are reporting losses have enough cash in the bank to get through.
These 16 nonprofit and for-profit entities, born out of the Affordable Care Act to provide health access by expanding Medicaid, generally grew financially stronger in in the first quarter of the year. And the numbers reveal that years after the first CCOs opened their doors, new members continue to enroll. An average of 954,658 Oregonians participated in these plans over the first quarter of 2016, up by 20,000 from last year’s average.
Here’s an up-close look at the state’s CCOs.
AllCare Health Plan
AllCare started as a for-profit physician owned-Medicaid plan in 1996, and was chosen in 2012 to operate as a CCO serving a number of communities in southern Oregon. Based in Grants Pass, it serves Jackson, Josephine and Curry counties, as well as southern Douglas County.
AllCare was profitable in 2015, despite net losses in the second half of last year. In the first quarter of this year, the company again reported positive net income, of $1.6 million. First-quarter net premium revenue was $56.6 million, down slightly from the $58.2 million net premium revenue of the first quarter of last year, but higher than the premiums collected in the third and fourth quarters of 2015.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $1.6 million.
- Average monthly medical spending per member: $312.35.
- Average members: 51,634.
- Days of cash on hand: 40.5
Cascade Health Alliance
Cascade Health Alliance is Klamath County’s CCO. A for-profit, it is a subsidiary of Cascade Comprehensive Care, which is comprised of a network of hospitals, doctors and clinics. CCC also administers the ATRIO Medicare health plans.
After reporting a profitable conclusion to 2015, Cascade Health Alliance continued to post profits in the first quarter of this year, with net income of $823,370.
With 121 days of cash on hand, this CCO is among the best positioned to weather financial hardship in the state, as it could continue operating for four months without revenue – a sign of financial health, though the scenario is very unlikely. Only Family Care, with 146 days of cash on hand, ranks higher on this scale in Oregon.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $823,370.
- Average monthly medical spending per member: $366.09.
- Average members: 16,685.
- Days of cash on hand: 121.06.
Columbia Pacific CCO
Columbia Pacific CCO is a nonprofit that serves Clatsop, Columbia and Tillamook counties.
Its financial snapshot portrays a CCO that is maintaining stability and consistency. Its net premiums – which were $35.3 million in the first quarter – have held relatively steady for the past year, and expenses are below revenue. Columbia Pacific has been working to bolster its cash reserves, which it would have to lean on in a financial crunch. After starting 2015 with just 7.36 days of cash on hand, as of March 31, 2016, the CCO had 22.36 days of cash on hand.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $502,273.
- Average monthly medical spending per member: $384.11.
- Average members: 27,441.
- Days of cash on hand: 22.36.
Eastern Oregon CCO
Formed in May 2012, Eastern Oregon CCO is owned half by ODS Community Health (a Moda Health Plan subsidiary) and half by Greater Oregon Behavioral Health Inc., and serves Medicaid members in 12 counties in eastern Oregon. It is administered by GOBHI.
After making nearly all of its 2015 profit in the fourth quarter of last year, Eastern Oregon CCO maintained its profitability in Q1 2016, reporting net income of $3.3 million. The cash and equivalents
on its balance sheet dropped by $7.9 million during the first quarter, to $44.4 million, but it still ended the quarter with 63.63 days of cash on hand – putting it in the middle of the pack among Oregon CCOs.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $3.3 million.
- Average monthly medical spending per member: $398.24.
- Average members: 49,053.
- Days of cash on hand: 63.63.
FamilyCare Inc
FamilyCare Inc. is a nonprofit whose roots go back to 1984. In addition to running a CCO that serves Clackamas, Multnomah, Washington and Marion counties, it also offers six Medicare Advantage plans in the Portland metro area, plus Clatsop, Morrow and Umatilla counties. From its start, FamilyCare has incorporated osteopathic medicine’s whole-body approach to its philosophy of care.
Of the four CCOs that reported net losses in the first quarter of 2016, FamilyCare’s was by far the biggest loss, at $10.2 million. (No. 2 biggest loss was $596,436, at Jackson Care Connect.) But that loss is not necessarily bad news: FamilyCare bolstered its cash and cash equivalents by $3.4 million, bringing this balance to $77.8 million. And with 146 days of cash on hand, it has the strongest cash reserves of any CCO in the state.
FamilyCare is Oregon’s second-largest CCO, serving about 125,962 people over the first quarter (behind only Health Share of Oregon, which served 240,040 members).
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net loss: $10.2 million.
- Average monthly medical spending per member: $328.26.
- Average members: 125,962.
- Days of cash on hand: 145.92.
Health Share of Oregon
Health Share of Oregon is a nonprofit founded by a consortium of healthcare organizations and service groups in the Portland metro area. It operates in Clackamas, Multnomah and Washington counties.
The largest CCO in Oregon, its financial situation offers a notable contrast with FamilyCare, second-largest in the state and also centered around the Portland metro area. While HealthShare was profitable, with net income of $3.2 million, and Family Care posted a net loss of $10.2 million, Health Share’s balance sheet is not necessarily as strong as its neighboring CCO.
With less than 8 days of cash on hand, HealthShare ranks at the bottom of this metric (far below second-from-the-bottom Willamette Valley Community Health, with about 18 days of cash on hand). That could bode poorly if HealthShare experiences a cash crunch in the future – although the CCO did increase its cash and equivalents by $9.5 million over the first quarter, to $22.9 million.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $3.2 million.
- Average monthly medical spending per member: $337.02.
- Average members: 240,040.
- Days of cash on hand: 7.79.
Intercommunity Health Network CCO
Intercommunity Health Network CCO is a nonprofit founded in 2012 by a consortium of healthcare groups within the communities it serves in the Willamette Valley and along the mid-Oregon coast. It is administered by Samaritan Health and operates in Benton, Linn and Lincoln counties.
IHN’s cash and equivalents continued to erode in the first quarter of 2016. The CCO started last year with $67.9 million in cash and equivalents and ended 2015 with $42.8 million. Cash and equivalents fell another $3.5 million in the first quarter of 2016, to $39.3 million. This may be an intentional strategy, as IHN has 115.6 days of cash on hand, far more than most of its fellow Oregon CCOs, and more than enough to weather any but the most extreme cash crunch.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $2.4 million.
- Average monthly medical spending per member: $370.15.
- Average members: 58,572.
- Days of cash on hand: 115.56.
Jackson Care Connect
Jackson Care Connect was created through a partnership with CareOregon and Jefferson Behavioral Health / Jackson Mental Health, plus a broad scope of other healthcare providers. It only serves Jackson County.
Jackson Care Connect is one of four Oregon CCOs to report a net loss in the first quarter of 2016. Its $596,438 net loss followed a profitable 2015, when it reported net income of $9.9 million. It had 23 days of cash on hand as of March 31, 2016.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $596,438.
- Average monthly medical spending per member: $329.99.
- Average members: 31,852.
- Days of cash on hand: 23.07.
PacificSource Community Solutions – Central Oregon & the Gorge
Eugene-based nonprofit PacificSource operates two coordinated care organizations, one in central Oregon and one in the Columbia River Gorge area, in addition to a traditional private health plan and Medicare offerings. The central Oregon plan is the larger of PacificSource’s two CCOs, with 53,125 members, compared to 13,123 in the Gorge CCO.
PacificSource’s Gorge CCO is also one of the four Oregon CCOs to report financial losses in the first quarter of the year. Its net loss of $54,777 was the smallest loss of the four. The company’s Central Oregon CCO reported a net profit of $1.5 million.
Financial statements break out some CCO-specific details, and combined both PacificSource CCOs into a single figure in other cases. The two CCOs combined have 54 days of cash on hand, according to the statements, which do not divide out the cash resources of the two subsidiaries separately. Combined cash and equivalents at the CCOs climbed $2.96 million during the quarter, to $46.4 million as of March 31.
The two CCOs reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income, Central CCO: $1.5 million.
- First quarter 2016 net loss, Gorge CCO: $54,777.
- Average monthly medical spending per member, Central CCO: $357.22
- Average monthly medical spending per member, Gorge CCO: $369.95.
- Average members, Central CCO: 53,125.
- Average members, Gorge CCO: 13,123.
- Days of cash on hand, PacificSource combined: 54.48.
PrimaryHealth of Josephine County
PrimaryHealth of Josephine County is a nonprofit founded in 2012 to serve its southern Oregon community as a CCO.
It reported net income of $1.6 million in the first quarter of 2016.
PrimaryHealth of Josephine County is Oregon’s smallest CCO, with 12,030 members (next-smallest is PacificSource’s Gorge CCO, with 13,123 members). It also provides care at the lowest cost among the state’s CCOs, at an average of $302.30 per member per month. (AllCare is second-lowest spending on care, at an average of $312.35 per month.)
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $1.6 million.
- Average monthly medical spending per member: $302.30.
- Average members: 12,030.
- Days of cash on hand: 43.34.
Trillium Community Health Plan
Trillium Community Health Plan is a for-profit that was already incorporated as an insurance company before it became a CCO, so it is licensed by both the Oregon Health Authority and the Department of Consumer and Business Services, which houses the state’s Insurance Division. It is owned by St. Louis-based Centene Corp., a Fortune 500 company.
With $160.7 million in total assets, Trillium has the second-most assets of any CCO in the state, after FamilyCare, which has $321.4 million.
Trillium reported that it received $4.3 million in quality incentive pool payments in the first quarter. It made no dividend payments.
By the numbers:
- First quarter 2016 net income: $3.9 million.
- Average monthly medical spending per member: $353.72.
- Average members: 97,811.
- Days of cash on hand: 69.18.
Umpqua Health Alliance
Though it does business as the Umpqua Health Alliance, this Douglas County-focused CCO is a for-profit legally incorporated under the name DCIPA LLC. It’s owned by Architrave Health LLC, which in turn is owned by Mercy Medical Center and medical practitioners within the region.
The CCO received $2.2 million in the quality incentive pool payments. It reported paying $1.33 million in dividends and distributions to its owners.
By the numbers:
- First quarter 2016 net income: $1.003 million.
- Average monthly medical spending per member: $357.70.
- Average members: 26,975.
- Days of cash on hand: 119.92.
Western Oregon Advanced Health
Created in 2012 to serve Coos County and northern Curry County, Western Oregon Advanced Health is run by a consortium of doctors along the Oregon coast. The for-profit company also owns South Coast Technical Innovations, a grant-funded business developing electronic record systems.
Western Oregon Advanced Health reported the highest per-member medical costs in the state, spending $427.22 on medical expenses per member each month. It had the highest costs in the state last year as well. Second-highest is Eastern Oregon CCO, which spent $398.24 per member per month in the first quarter.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $358,583.
- Average monthly medical spending per member: $427.22.
- Average members: 20,176.
- Days of cash on hand: 25.06.
Willamette Valley Community Health LLC
Willamette Valley Community Health was organized in 2012 to serve Marion and Polk counties. It is a for-profit, but is owned by mutual-benefit nonprofit Mid Valley IPA, a physicians and healthcare providers group, which runs WVCH very much like a nonprofit group, with a local board and local advisory groups.
After ending 2015 with just 12 days of cash on hand, WVCH has been improving its cash position. It ended the first quarter of 2016 with18 days of cash on hand. Over the course of the quarter, it increased its cash and equivalents balance by $5 million, to $21.8 million.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net income: $688,934.
- Average monthly medical spending per member: $332.83.
- Average members: 104,889.
- Days of cash on hand: 17.74.
Yamhill Community Care Organization
Created in 2012 to serve Yamhill and parts of Clackamas, Washington, Polk, Marion and Tillamook Counties, Yamhill Community Care Organization is a registered nonprofit.
One of the four CCOs to report a loss in the first quarter of 2016, Yamhill CCO’s loss was $553,814.
The CCO reported no dividend payments to stockholders, and no quality incentive revenue, in the quarter.
By the numbers:
- First quarter 2016 net loss: $553,814.
- Average monthly medical spending per member: $340.50.
- Average members: 25,289.
- Days of cash on hand: 75.10.
