CMS Approves Accountability Measures

The coordinated care organizations will be graded on 17 metrics regarding access and quality of care, and be rewarded additional funds from a bonus pool

January 16, 2013 -- The federal Centers for Medicare and Medicaid Services has given final approval to a waiver that includes a list of 17 accountability measures for Oregon’s new coordinated care organizations, which are providing care to the state’s Medicaid population through the Oregon Health Plan.

CMS ordered a last-minute adjustment that requires the CCOs to monitor the follow-up care for children who receive drugs for attention deficit hyperactivity disorder.

“They really wanted us to have a behavioral health measure that focused on children,” Oregon Health Authority Chief of Policy Tina Edlund told The Lund Report.

The ADHD metric replaces one of the provisional measures tracking treatment for drug and alcohol abuse. CCOs will still have to chart such clients through the “screening, brief intervention and treatment” model. “They felt the two measures were so similar that one could be dropped,” Edlund said.

An accountability plan was part of the special terms and conditions needed for formal approval of the CMS waiver, on Dec. 18. The CCOs will be graded on 17 metrics regarding access and quality of care. Organizations that meet performance standards will be rewarded additional funds from a bonus pool.

Oregon received $1.9 billion in extra federal funding to implement CCOs for its Medicaid program, with the promise that the state would reduce per-patient costs for the Oregon Health Plan by two percentage points by the end of the second year.

The accountability measures are a way to help ensure that Oregon does so without skimping on coverage.

In addition to gauging treatment for ADHD and substance abuse, the state will track several prenatal and maternal care measures, access measures and mental health screenings.

Lillian Shirley, director of the Multnomah County Health Department, was especially pleased with three measures that track preventive health care for chronic illnesses — colo-rectal cancer screening, diabetes care and high blood pressure. “We are hitting some of the biggest disparities for low-income people and people of color,” she said.

The Oregon Health Policy Board also approved the health plan for new Medicaid patients who will join the system in 2014 thanks to the federal healthcare expansion. Oregon residents up to 133 percent of the federal poverty level (about $15,000 for a single person) will be eligible, and the current lottery system will be eliminated, Edlund said.

Jim Russell, who chairs the state Medicaid Advisory Board, tasked with developing a plan for the new Medicaid clients, said they were forced to improve upon the current standard Oregon Health Plan because it does not include rehabilitative services required by the new federal law.

Felisa Hagins expects the 200,000 new Oregon Health Plan members to have a backlog of health problems after years without insurance. “The expansion will help us lower costs long-term, but you’ll see this huge population who haven’t had healthcare in 10 years coming in with huge costs in the first three years,” said Hagins, the political director of the Service Employees International Union Local 49.

Despite requirements that Oregon’s CCO model show lower costs per patient, Edlund said Oregon will be better prepared to absorb these costly patients because of coordinated care.

“This was a huge part of the importance to implement the CCO model,” she said.  

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