All of Oregon’s 16 community care organizations were profitable in the first nine months of 2015, according to internal financial statements published Friday by the Oregon Health Authority. And several CCOs have strong cash reserves.
These nonprofit and for-profit entities, born out of the Affordable Care Act to provide health access by expanding Medicaid, grew financially stronger in the first three quarters of 2015.
At the end of last year, Columbia Pacific CCO and Health Share of Oregon reported such limited cash on hand that they might not be able to last more than a few days in a crisis. The latest reports show that they’ve made strides to bolster their cash reserves.
One CCO, AllCare, reported paying $6 million in dividends to its owners – while none of the other CCOs indicated they made such payments. Some CCOs may have repaid loans or paid for administrative services offered by their owners, which would not be recorded as dividends.
Click here for a spreadsheet that highlights key financial metrics for the state’s CCOs.
Here’s an up-close look at the state’s 16 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 Jackson and Curry counties in southern Oregon.
AllCare received $606,526 in the first quarter of 2015 and $5.6 million in the second quarter under the state’s quality incentive pool program. This program makes payments to CCOs that are “improving care, making quality care accessible, eliminating health disparities, and curbing the rising cost of healthcare” – with the financial rewards based on how well each CCO meets measures and benchmarks set out by the state.
As a for-profit business, AllCare pays dividends to its physician owners -- $6 million in the second quarter of 2015.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $9.3 million.
- Third quarter 2015, average monthly medical spending per member: $301.70.
- Third quarter 2015, average members: 51,264.
- Sept. 30, 2015, days of cash on hand: 52.39, up from 50.62 at the start of the year.
Cascade Health Alliance
Cascade Health Alliance is Klamath County’s CCO, a for-profit, and a subsidiary of Cascade Comprehensive Care, which is comprised of a network of hospitals, doctors and clinics. CCC also administers Atrio Medicare health plans.
Cascade Health Alliance did not report paying any dividends or receiving any quality incentive pool payments in the first nine months of 2015.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $1.6 million.
- Third quarter 2015, average monthly medical spending per member: $324.35.
- Third quarter 2015, average members: 15,983.
- Sept. 30, 2015, days of cash on hand: 87.23, about even with 87.85 at the start of the year.
Columbia Pacific CCO
Columbia Pacific CCO is a nonprofit that serves Clatsop, Columbia and Tillamook counties.
It received $1.2 million in the second quarter of 2015 under Oregon’s quality incentive pool program, which rewards CCOs for meeting benchmarks and metrics determined by the Oregon Health Authority. At the beginning of last year, Columbia Pacific CCO had just enough cash in the bank to continue operating for about seven and a half days if it ran into a crisis. By Sept. 30, 2015, it had significantly bolstered its cash on hand, to 17.55 days.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $2.1 million.
- Third quarter 2015, average monthly medical spending per member: $389.24.
- Third quarter 2015, average members: 26,878.
- Sept. 30, 2015, days of cash on hand: 17.55, up from 7.36 at the start of the year.
Eastern Oregon CCO
Formed in May 2012, Eastern Oregon CCO is owned half by ODS Community Health (a Moda Health subsidiary) and half by Greater Oregon Behavioral Health Inc., and serves Medicaid members in 12 counties in eastern Oregon.
It received $6.8 million in the second quarter of 2015 under Oregon’s quality incentive program.
Eastern Oregon CCO’s net income, or profit, was just $247,485 from Jan. 1 through Sept. 30, 2015, in large part because of a $2.3 million net operating loss in the second quarter of the year, when member expenses were $62.3 million – nearly $10 million higher than in Q1 or Q3. No one single type of medical expense is to blame – physician services were up by about $4 million, labs and x-ray charges were higher, as were vision charges, and mental health costs – “other member service expenses” is the big one, though, with $8.05 million. The CCO’s financial report does not explain which services fall into that category.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $497,485.
- Third quarter 2015, average monthly medical spending per member: $386.11.
- Third quarter 2015, average members: 47,488.
- Sept. 30, 2015, days of cash on hand: 70.64, down from 73.11 at the start of the year.
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.
FamilyCare received $1.3 million in the first quarter of 2015, and $14.6 million in the second quarter, through Oregon’s quality incentive pool, as a financial reward for meeting benchmarks and metrics set by the state.
Its net income, or profit after all expenses, was $9.5 million for the first nine months of 2015 – notably lower than its net operating profit of $20.7 million. The discrepancy can largely be attributed to a $4.5 million net investment loss in the second quarter of last year and a $7 million net investment loss in the third quarter. (In the first quarter, net investment income was positive, at $350,468.) Details about those losses were not included in its financial reports.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $9.5 million.
- Third quarter 2015, average monthly medical spending per member: $336.81.
- Third quarter 2015, average members: 121,672.
- Sept. 30, 2015, days of cash on hand: 140.91, virtually unchanged from 141.70 at the start of the year.
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.
It received $2.7 million in the first quarter of 2015, and $18.4 million in the second quarter, through Oregon’s quality incentive pool, as a financial reward for meeting benchmarks and metrics set by the state.
Health Share has consistently had the fewest days cash on hand of all of Oregon’s CCOs. In a crisis, it would have enough cash to cover six and a half days of expenses. That’s an improvement from the start of the year, when it only had three days of cash on hand. It’s worth noting that it takes a lot more cash to run Health Share than any other CCO, so having many days of cash on hand requires a substantial balance: Its spending on healthcare for its members was $744.9 million from January through September of last year, more than twice that of the next-biggest spender (FamilyCare).
Among the CCOs, Health Share was one of the most profitable, ending the third quarter just under $20 million in net income. InterCommunity Health Network nearly matched that amount.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $19.04 million.
- Third quarter 2015, average monthly medical spending per member: $339.64.
- Third quarter 2015, average members: 239,341.
- Sept. 30, 2015, days of cash on hand: 6.51, up from 2.59 at the start of the year.
Intercommunity Health Network
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’s administered by Samaritan Health and operates in Benton, Linn and Lincoln counties.
It did not report any quality incentive pool payments in the first nine months of 2015.
IHN is the Oregon CCO best equipped to weather a cash crisis. It had 143.49 days of cash on hand, more than any of its peers.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $18.5 million.
- Third quarter 2015, average monthly medical spending per member: $343.12.
- Third quarter 2015, average members: 57,279.
- Sept. 30, 2015, days of cash on hand: 143.49 up from 109.32 at the start of the year.
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, and serves Jackson County.
Jackson Care Connect received $396,800 in the first quarter of 2015, and $710,382 in the second quarter, through Oregon’s quality incentive pool, as a financial reward for meeting benchmarks and metrics set by the state.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $6 million.
- Third quarter 2015, average monthly medical spending per member: $302.31.
- Third quarter 2015, average members: 31,141.
- Sept. 30, 2015, days of cash on hand: 25.96, up from 10.18 at the start of the year.
PacificSource Community Solutions
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 52,310 members, compared to 12,840 in the Central Oregon CCO.
PacificSource’s CCO plans received $5.8 million in the second quarter of 2015 through Oregon’s quality incentive pool, as a financial reward for meeting benchmarks and metrics set by the state.
A few key figures for the central Oregon plan: net premiums: $197.9 million; member service expenses: $169.3 million; net operating income: $17.7 million; net income: $10.8 million
Key figures for the Columbia Gorge plan: net premiums: $48 million; member service expenses: $35.97 million; net operating income: $9.3 million; net income: $6.7 million.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income, both CCOs combined: $13.6 million.
- Third quarter 2015, average monthly medical spending per member, central Oregon: $351.30.
- Third quarter 2015, average monthly medical spending per member, Columbia River Gorge: $307.92.
- Third quarter 2015, average members, central Oregon: 52,310.
- Third quarter 2015, average members, Columbia River Gorge: 12,840
- Sept. 30, 2015, days of cash on hand, both CCOs: 67.76, up from 48.98 at the start of the year.
PrimaryHealth of Josephine County
PrimaryHealth of Josephine County is a nonprofit founded in 2012 to serve its southern Oregon community as a CCO.
It received $1.6 million in the second quarter of 2015 through Oregon’s quality incentive pool, as a financial reward for meeting benchmarks and metrics set by the state.
PrimaryHealth has seen the cost of providing medical care rise more rapidly than the revenue it receives from premiums this year. That revenue went from $12.2 million in the first quarter to $12.6 million in the second to $13.4 million in the third. Spending on member care went from $9.96 million in the first quarter to $11.7 million in the second to $13.1 million in the third. After administrative costs and other expenses, the CCO reported a net loss of $725,354 in the third quarter of 2015 – though profits in the first two quarters were enough to leave PrimaryHealth with net income, or profit, of $2.4 million for the full January-to-September period.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $2.4 million.
- Third quarter 2015, average monthly medical spending per member: $329.51.
- Third quarter 2015, average members: 11,705.
- Sept. 30, 2015, days of cash on hand: 53.47, up from 19.58 at the start of the year.
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. Now owned by Centene Corporation, Trillium files National Association of Insurance Commissioner reports with insurance and
CCO regulators, rather than the financial documents submitted by the other CCOs. As a result, the financial figures available for Trillium are slightly different, and per member per month healthcare spending is not available.
Trillium reported that from Jan. 1 through Sept. 30, 2015, it received $5.1 million in “incentive pool, withhold adjustments and bonus amounts,” which may be comparable to the quality incentive pool payments other CCOs received. But, because the forms and language used by Trillium are different than the rest of the state’s CCOs, it’s impossible to make a perfect comparison.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $6.8 million.
- Third quarter 2015, average monthly medical spending per member: Not available.
- Sept. 30, 2015, total members: 96,004 in Trillium’s CCO (Medicaid) health plans, and 4,143 in its Medicare plans.
- Sept. 30, 2015, days of cash on hand: Not available.
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.
Umpqua Health Alliance received $372,829 in the first quarter of 2015, and $4.1 million in the second, through Oregon’s quality incentive pool, as a financial reward for meeting benchmarks and metrics set by the state.
The CCO’s operations were profitable, but its investing and financing activities led to a net decrease in cash and cash equivalents of $7.2 million.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $7.7 million.
- Third quarter 2015, average monthly medical spending per member: $344.97.
- Third quarter 2015, average members: 26,152.
- Sept. 30, 2015, days of cash on hand: 140, up slightly from 138.43 at the start of the year.
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.
WOAH did not report receiving any quality incentive pool payments in the first nine months of 2015.
In the third quarter of last year, it spent more on medical care per member than any other CCO in the state -- $412 per member per month. The statewide median is $336.81 per member per month.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $1.03 million.
- Third quarter 2015, average monthly medical spending per member: $412.02.
- Third quarter 2015, average members: 19,391.
- Sept. 30, 2015, days of cash on hand: 27.61, up from 14.97 at the start of the year.
Willamette Valley Community Health LLC
Willamette Valley Community Health was established in 2012 to serve Marion and Polk counties. As a for profit enterprise, it’s owned by mutual-benefit nonprofit Mid Valley IPA, a physician and healthcare provider group, which runs WVCH very much like a nonprofit group, with a local board and local advisory groups.
WVCH received $6.1 million in the second quarter of 2015 through Oregon’s quality incentive pool, as a financial reward for meeting benchmarks and metrics set by the state.
In the third quarter of last year, it spent less on medical care per member than any other CCO in the state -- $295.21 per member per month, compared to the statewide median of $336.81 per member per month.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $6.2 million.
- Third quarter 2015, average monthly spending per member: $295.21.
- Third quarter 2015, average members: 103,040.
- Sept. 30, 2015, days of cash on hand: 22.86, up slightly from 21.14 at the start of the year.
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 registered as a nonprofit.
Yamhill CCO received $1.4 million in the second quarter of 2015 through Oregon’s quality incentive pool, as a financial reward for meeting benchmarks and metrics set by the state.
By the numbers:
- Jan. 1 – Sept. 30, 2015, net income: $5.7 million.
- Third quarter 2015, average monthly medical spending per member: $325.62.
- Third quarter 2015, average members: 22,208.
- Sept. 30, 2015, days of cash on hand: 81.05, up from 70.65 at the start of the year.
Correction: An earlier version of this story listed an incorrect figure for medical spending by Health Share. The story has been updated to reflect correct financial data.
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Courtney Sherwood can be reached at [email protected]. Follow her on Twitter at @csherwood.
