Kotek Joins Greenlick in Pushing for CCO Reform, Against Resistance

Rep. Greenlick introduced legislation calling for better controls on CCO reserves and more transparent accounting by the organizations, which use tax dollars to provide healthcare for the state’s neediest residents.

Rep. Mitch Greenlick, D-Portland, rolled out his coordinated care organization reform bill on Monday with the support of House Speaker Tina Kotek, D-Portland.

Greenlick intends to build on the success of locally driven reforms to the state Medicaid program by requiring CCOs to be more transparent and more accountable while protecting the public investment in the health of the state’s children, low-income adults and disabled people.

“We’ve done an amazing job over the past five years, but now we have to talk about making it more sustainable,” Greenlick said.

Perhaps the biggest concern occurred after the sale of Lane County CCO Trillium to the Missouri’s Centene Corporation. Several of Trillium’s stakeholders became overnight millionaires based on the value of their company as it has profited from the Medicaid system.

In addition to their profitability, Trillium and other CCOs have reserves of public money that total nearly $1 billion statewide, which Greenlick says could be at risk. Centene pulled the plug on its Kentucky Spirit managed care organization in the Bluegrass State, leading the state to sue for $174 million.

House Bill 2122 would immediately set up an escrow fund in the state treasury that would transfer those reserves and set up a process for the CCOs to tap into the money through a subaccount when needed. “It’s our responsibility to protect those dollars,” said Kotek.

The bill also tasks the Oregon Health Policy Board with streamlining and toughening the quality-control metrics that CCOs need to meet to receive money from a bonus pool. And CCOs would be required to pay for 80 percent of their medical bills through an alternative-payment structure as opposed to paying a set rate for volume. At the start of the new contract, CCOs would then have to submit a plan for meeting these new standards by 2023.

Lobbyists from the CCOs are pushing back on Greenlick’s bill, none moreso than those from the Coalition for a Healthy Oregon, or COHO, a group of mainly for-profit CCOs that serve Oregon Health Plan members across western Oregon, as well as the not-for-profit FamilyCare in the Portland metro area.

“It’s one of the most upsetting and uncertain times in healthcare, ever,” said Josh Balloch, the lobbyist for All-Care, a COHO member in southwest Oregon. “I believe this is a little too much, too fast.”

Balloch noted that the new Medicaid waiver already requires CCOs to increase their medical-loss ratio from 80 to 85 percent of total cost, and they must spend an additional 2 percent on upstream investments into the social determinants of health.

Most of the reforms that Greenlick has outlined would not take place until 2023 to give CCOs time to adjust. COHO’s biggest objection is to being forced to change from a for-profit to a community-based non-profit, and in the past some of their member organizations have objected to new transparency measures, such as requirements they open up their records and board meetings to public scrutiny.

“They have a legal obligation to look out first for their shareholders,” Greenlick said of for-profit healthcare companies.

But COHO lobbyist Courtney Johnson said their models have been working: “We have been successful because we have been accountable to our local communities.”

Other CCO representatives have been more circumspect, with Jonathan Eames of Health Share, a Portland CCO, saying his organization supports the aims and goals of the legislation, while Jeremiah Rigsby of CareOregon, which delivers care for Health Share and two other CCOs, said he wanted increased standards for quality care.

If Greenlick has to compromise it may be in forcing the profit to non-profit switch, with an amendment that adopts instead a reform approach suggested by the Oregon Health Policy Board, which organized community meetings around the state before advocating for transparency. “The Oregon Health Policy Board did a fabulous job,” the state representative earlier told The Lund Report. “They would trade transparency for gaining the non-profit status.”

He said transparency was especially important because every dollar the CCOs spend is public money.

Jesse O’Brien, a healthcare advocate at the Oregon State Public Interest Group, agreed: “We need more accountability in governance. We need to know where our money is going. We need to continue to raise the bar.”

Chris Gray can be reached at [email protected].

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