With one exception, Oregon’s coordinated care organizations (CCOs) all reported strong profits in recently published second quarter financial reports through June 30, 2015. At mid-year, several CCOs (Cascade Health Alliance, Health Share of Oregon, and PrimaryHealth of Josephine County) were already meeting or exceeding their entire net income of the previous year. On the flip side, Eastern Oregon CCO reported a loss of $1 million net income (although with plenty of cash reserves – 55 days on hand).
Three CCOs had more than 100 days cash on hand, with Umpqua Health Alliance leading the others at 142 days of cash reserves. On the flip side, Health Share of Oregon, although showing strong profits, has only 14.8 days of cash reserves on hand.
Oregon’s 16 CCOs were licensed in 2012 to provide healthcare to people on Medicaid as a requirement of the Affordable Care Act. To provide more transparency and help improve the quality of healthcare for low-income Oregonians, the Oregon Health Authority publishes the CCO’s quarterly progress reports including financial statements.
Here is a snapshot of each of the 16 CCOs financial progress in 2015. (Click here for more detailed financial highlights).
AllCare CCO, Inc.
One of the first CCOs in Oregon, AllCare Health Plan incorporated in 2004. Without changing its structure, the organization recently changed its name to AllCare CCO, Inc. (AllCare). AllCare contracts with 10 independent Risk Accepting Entities (“RAE”) to provide healthcare in Jackson and Curry counties.
By June 30, 2015, AllCare reported $12.3 million net spending and average of $304.50 per healthcare member per month.
Cascade Health Alliance
Cascade Health Alliance is a wholly owned subsidiary of Cascade Comprehensive Care, and is a successor to Klamath Comprehensive, Inc., providing healthcare to members in Klamath country. The organization signed a Memorandum of Understanding to provide a mental health safety net after Klamath County made the decision to close the County Mental Health Department in June 2013.
Cascade Health Alliance reported $1.6 million net income in its 2015 year-to-date filings, spending $317.58 per member per month.
Columbia Pacific CCO
Columbia Pacific CCO provides healthcare services to members in Clatsop, Columbia, and Tillamook counties. Previously the organization offered coverage in Reedsport and portions of Coos County, but members in those communities were transferred to Trillium or Western Oregon Advanced Health earlier last spring.
Columbia Pacific CCO reported slightly more than $1 million net income by June 30, 2015, spending $370.17 per member per month on average.
Eastern Oregon CCO
Eastern Oregon CCO provides healthcare services to 12 counties in Eastern Oregon. ODS Community Health, Inc. (ODSCH), and Greater Oregon Behavioral Health, Inc. (GOBHI) formed the CCO in 2012 each with a 50% contribution. ODSCH is a wholly owned subsidiary of Moda Health Plan, Inc. (MHP), which is wholly owned by Moda, Inc. In May 2013, six hospitals and clinics contributed funds to acquire 42% ownership, reducing ODSCH and GOBHI’s ownership to 29% each.
Eastern Oregon CCO is the only healthcare organization reporting a loss during the second quarter in 2015. The CCO reported a net income loss of $1.1 million, spending $304.92 per healthcare member on average each month. In spite of showing a loss, the CCO reported cash on hand for 55 days.
A Portland-based nonprofit, FamilyCare and its subsidiaries - Family Care Health Plans, Inc. and the Heatherington Foundation for Innovation and Education in Healthcare (the Foundation) - provides cooperative and comprehensive healthcare services to residents in Multnomah, Clackamas, Washington and part of Marion county.
The Foundation was established as an organization in December 2014 through a contribution from FamilyCare to support innovation for improvements in healthcare and to fund healthcare education efforts.
FamilyCare reported $13.1 million net income in its 2015 year-to-date filings, spending an average of $343.29 per healthcare member per month. Incidentally, the CCO’s cost per member increased from one of the lowest in 2014 at $244.59 per member per month.
Health Share of Oregon CCO
Health Share of Oregon is a nonprofit public benefit corporation providing healthcare services to its Portland Tri-County Region members in Clackamas, Multnomah, and Washington counties. The CCO began offering dental coverage in January 2014. At the first of the year in 2015, the organization added the additional service of providing non-emergent medical transportation (NEMT).
Health Share of Oregon contracts with fourteen independent Risk Accepting Entities (RAE): CareOregon, Inc., Kaiser Foundation Health Plan, Providence Health Assurance, Tuality Health Alliance, Clackamas County Health Department, Multnomah County Health Department, Washington County Department of Health and Human Services, Access Dental Plan, Advantage Dental, Capitol Dental Care, Family Dental Care, Managed Dental Care, ODS Community Health, and Willamette Dental Group.
In the second quarter, Health Share of Oregon reported $15.5 million net income in 2015, exceeding its reported net earnings for all of 2014 ($15.1 million). Despite this financial achievement, the organization reported just 14.8 days cash on hand, making it the CCO with lowest cash reserves reported for 2015. The CCO spent $341.87 per healthcare member on average per month.
Intercommunity Health Network CCO
Intercommunity Health Network (IHN) is a nonprofit and subsidiary of Samaritan Health Services, Inc., founded in 1994. The CCO contracts for healthcare services with hospitals, multispecialty and primary care physician organizations and other providers in the Willamette Valley and mid-Oregon coast with a focus on preventative care and health education.
In 2015, Intercommunity Health Network reported $12.2 million net income at the end of this year’s second quarter, spending $356.48 per member per month.
Jackson Care Connect
Jackson Care Connect provides healthcare to members in Jackson county. The CCO reported $4.2 million net income year-to-date in 2015, at a cost of $303.74 per member on average per month.
In December 2014, PacificSource Community Health Plans, Inc. merged into a newly formed not-for-profit health care contractor with service areas in Central Oregon and the Gorge.
The CCOs reported $8.9 net income separately for each of its two organizations, Central Oregon and the Gorge. The Central Oregon CCO spent $347 per member per month while the Gorge spent $300.01.
PrimaryHealth of Josephine County
PrimaryHealth of Josephine County, LLC, is a subsidiary of Oregon Health Management Services (the company). The company, formed in 1995, purchased PrimaryHealth from CareOregon in December 2013. The CCO provides medical, dental and mental health services in Josephine County, as well as the contiguous zip codes of Jackson and Douglas Counties, Oregon.
By the end of June 2015, the CCO reported $2.9 million net income, more than three times that reported in 2014 ($890,982). The organization’s per member cost per month is $307.44. With more than 60 days cash on hand, the CCO ends the second quarter with the highest net profit margin of 11.08% in 2015.
Trillium Community Health Plan
Trillium is owned 60% by Lane Individual Practice Association (LIPA) in Jackson County and Lane County, and 40% by Agate Resources, Inc. LIPA is a wholly-owned subsidiary of Agate. Although Trillium is a CCO, it also owns an insurance line of business and therefore must file reports with the National Association of Insurance Commissioner (NAIC) as well as with CCO regulators. For this reason, its financial statements are a little different than other CCOs and does not report an average monthly cost per member.
Trillium’s total NAIC reported net income (for all services) in the second quarter of 2015 is $12.5 million.
Umpqua Health Alliance
Incorporated under the name DCIPA LLC., Umpqua Health Alliance provides healthcare services to members in Douglas County. The CCO is owned by Architrave Health LLC, which in turn is owned by Mercy Medical Center and medical practitioners within the region.
Umpqua Health Alliance reported $6.6 million net income in June 2015, with $362.70 average cost per member per month.
Western Oregon Advanced Health
The CCO, Western Oregon Advanced Health, LLC (WOAH), contracts with independent Risk Accepting Entities (RAE) to provide physical, mental, and dental coverage in Coos County and northern Curry County.
In the second quarter of 2015, WOAH reported net income of $692,442. As in 2014, this CCO spent the highest in healthcare services of $412.61 on average per member per month.
Willamette Valley Community Health LLC (WVCH)
Willamette Valley Community Health is an Oregon LLC providing healthcare services to members in Marion and Polk counties. The CCO expanded to include dental coverage in
October 2013. In July 2014, Willamette Valley Community Health LLC (WVCH) implemented a non-emergent medical transportation (NEMT) service.
WVCH reported $7.5 million net income by the end of June 2015, spending an average of $290.52 per member per month.
Yamhill Community Care Organization (Yamhill CCO) is a nonprofit CCO serving members in Yamhill County. The organization began providing dental coverage to its members in January 2014. At the beginning of 2015, the CCO terminated its contract with Mid‐Valley Behavioral Care Network (MVBCN) and contracted with Yamhill County Health and Human Services to provide services to behavioral health enrollees.
In the second quarter of 2015, Yamhill CCO reported net income of $2.8 million, spending $324.26 per member per month on average.
Kathryn can be reached at [email protected]