Coordinated Care Organization Progress Data Shows Continued Reduction in Emergency Department Visits, Lower Costs

Oregon‘s fourth Health System Transformation report indicates that the coordinated care model is continuing to improve key areas of care for Oregon’s Medicaid population, while keeping costs down. The report released today shows coordinated care organization (CCO) progress for the first nine months of 2013 on key performance and cost measurements.


“Emergency department visits and spending are decreasing under the coordinated care model,” said Tina Edlund, acting OHA Director. Measurements indicate Oregon’s CCOs are lowering unnecessary hospitalizations for conditions that can better be treated elsewhere. “There are also reductions in hospital readmissions, largely due to community efforts to achieve the highest quality care and to keep people at their healthiest,” she said.


At the same time emergency department use is decreasing, primary care use is increasing. As hospitalizations are decreasing in key areas, Oregon Health Plan (OHP) members are receiving better and more appropriate care in the right place, at the right time. Patient-centered primary care enrollment, a key element of coordinated care, is also showing continued improvement.


This report also points to improvements in early developmental screenings. The percentage of children 36 months of age or younger who were screened for the risk of developmental, behavioral and social delays increased from a 2011 baseline of 21 percent, up to 32 percent in the first nine months of 2013. By identifying and addressing a child’s needs early, this transformational work leads to better health outcomes, reduced costs, and improved learning in these critical early years.

Highlighted findings

  • Decreased emergency department visits: Nine full months of reporting shows that emergency department visits by people served by CCOs has decreased 13 percent from 2011 baseline data.
  • Decreased hospitalization for chronic conditions: Coordinated care organizations reduced hospital admissions for congestive heart failure by 32 percent, chronic obstructive pulmonary disease by 36 percent, and adult asthma by 18 percent.


  • Increased primary care: Spending for primary care is up more than 18 percent. Enrollment in patient-centered primary care homes has also increased by 51 percent since 2012, the baseline year for that program. More than two-thirds of CCO members are now enrolled in patient-centered primary care homes. 
  • Increased adoption of electronic health records: Electronic health record adoption among measured providers has doubled. In 2011, 28 percent of eligible providers had adopted electronic health records. By September of 2013, 58 percent of eligible providers were using them.
  • All-cause readmission: The percentage of adults who had a hospital stay and were readmitted for any reason within 30 days of discharge dropped from a 2011 baseline of 12.3 percent to 11.3 percent in the first nine months of 2013, a reduction of 8 percent.

Each quarterly report shows us more than we knew before and more than has ever before been gathered and reported publicly in Oregon’s Medicaid program. We can use the metrics as a tool for improvement, CCO members learn more about what to expect from care, and we can use it as a standard to guide other types of health plans.

More than 600,000 Oregonians were enrolled in OHP in 2013. More than 180,000 Oregonians became new OHP members so far in 2014. Over the next several years, more Oregonians will continue to join OHP. By using the coordinated care model, focused on improved quality and lower costs, we can ensure a more sustainable system.


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We should stay on this trend. One key way to do that would be to decrease ER visits for emotional-distress/mental-health issues. We need less-intimidating ways for persons to access respite if they self-refer. Without this, behaviors escalate until others refer the person. Those of us who have been tasked with keeping agitated children from hurting themselves or others in an ER room can understand the importance of this. There is equipment that can be broken or misused in a room designed for treating physical injuries. Another issue is getting an agitated person to wait and wait. Often security personnel are involved in this, Taking people to facilities dedicated to these issues would relieve ER staff of having to worry about these things as they are working to deal with accident victims, heart-attacks, and other traumas that require different attention. Physical exams for persons in emotional distress do not require the same equipment as that for persons coming in from car crashes. This is one of those changes that would decrease excess-disability statistics. Western Lapland, in Finland, sends community teams out on initial call from concerned friends and family, and they have the best outcome statistics, in beating long-term disability, in Europe, save maybe Trieste, Italy, which has a recovery-through-work system.