By the Metrics: FamilyCare vs Health Share

Reports and surveys show the two CCOs achieving similar statistical results, but state officials acknowledge that current metrics need improvement. More FamilyCare members report poor mental health than Health Share members.

As tens of thousands of FamilyCare members receive letters about the end of their coordinated care organization and their pending switch to Health Share, state leaders have repeatedly emphasized that both Portland-area Medicaid providers rank similarly on statewide metrics.

All CCOs in the state are scored on a number of metrics. The state sets benchmark goals for each to achieve, and also rates them on improvement targets if they are not yet at the benchmark but are moving in the right direction.

These measurements are far from perfect, and providers have noted that some of the measures the Oregon Health Authority tracks and rewards CCOs for do not actually correlate to better results.

OHA Director Pat Allen acknowledged as much earlier this month. “We’re not doing a good enough job using the data and reports we generate to oversee the CCO system,” he said, noting that the Oregon Health Policy Board’s effort to define “CCO 2.0” seeks to develop better ways to measure and hold coordinated care organizations accountable.

Still, with providers and patients expressing deep concern about the fate of 115,000 FamilyCare members when that CCO shuts down at the end of this month, a side-by-side comparison with Health Share, which will take on most of those members, does offer some insight into what to expect.

Both FamilyCare and Health Share reported similar results on a number of metrics – failing to meet some targets, succeeding at others. Here’s what the data tells us.

Both failed to meet their targets on these metrics:

  • Access to care

  • Ambulatory care/ emergency department utilization

  • Childhood immunization

  • Diabetes control (EHR)

  • Effective contraceptive use

Both met their improvement targets on these, but did not reach full benchmark goals:

  • Adolescent well-care visits

  • Assessments for children in DHS custody

  • Prenatal and post-partum care

Both achieved statewide benchmarks:

  • Alcohol and drug misuse screening

  • Colorectal cancer screening

  • Dental sealants for children

  • Depression screening and follow-up (EHR)

  • Developmental screening

  • Patient-centered primary care home enrollment

 

Health Share ranked notably better than FamilyCare in two areas:

  • Cigarette smoking prevalence: Though both met improvement goals, Health Share was the best CCO in Oregon on this metric.

  • Follow up on hospitalization for mental illness: FamilyCare met its improvement target, but Health Share hit the more challenging to achieve benchmark

FamilyCare ranked notably better than Health Share in one area:

  • Satisfaction with care: FamilyCare met its improvement target and Health Share did not

Mental Health Up Close

Mental health providers have been especially vocal about the differences between the Portland area’s two CCOs. While Health Share member mental health is managed by a multi-county consortium, FamilyCare has traditionally paid above-Medicaid rates to private practices. Providers at these practices are worried about making ends meet without FamilyCare’s revenues – and many have expressed concern about the quality of care their patients will receive when Health Share takes over.

Detailed surveys answered by hundreds of members of both CCOs offer some insight into the different experiences and demographics of the two organizations.

When adult members of the two CCOs were asked to rate their overall mental or emotional health, 74 percent at FamilyCare said it was excellent, very good or good, and 77 percent at Health Share gave the same response.

At FamilyCare, 10 percent of adult respondents said their mental or emotional health was poor, compared to 6 percent at Health Share.

Though adults at FamilyCare seem to have grater mental health needs, children at the two were comparable, with 91 percent at Health Share in excellent, very good or good mental health and 92 percent at FamilyCare reporting the same.

Reach Courtney Sherwood at [email protected]

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