Oregon Health Authority Finalizes COVID-19 Vaccine Incentives For CCOs

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The Oregon Health Authority has finalized its plans for a COVID-19 vaccination incentive that could give Medicaid insurers an estimated $25 million for pushing up the inoculation rates of their members, an agency spokesman confirmed Friday. 

The final version of the health authority’s COVID-19 vaccination metric is vastly pared down from the agency’s earlier proposals that would have set a higher target for CCOs and tied nearly $100 million in incentive money to vaccination-rate improvements. 

Officials will finalize the estimated $25 million figure in November. The money will go toward the work of vaccinating Oregon’s Medicaid members -- 1.3 million people, or about one-quarter of the state’s population. This segment of the population has some of the lowest vaccination rates in Oregon. The health authority is encouraging insurers, health care providers and community-based groups to increase rates across-the-board, including among hard to reach groups.

For various reasons, from vaccine hesitancy to lack of transportation and lack of computer access to schedule appointments, Medicaid members around the state have been much slower than the population at large to get vaccinated. While the state is closing in on a 70% vaccination rate for adult Oregonians, the vaccination rates for Medicaid members 16 and older in many rural parts of the state languishes at 25% to 30%.

The state’s plan will put nearly one-eighth of the annual incentive funding for Medicaid insurers -- also called coordinated care organizations -- towards COVID-19 vaccinations. To qualify, CCOs will have to reach either a 70% vaccination rate for their members by Dec. 31 or hit a CCO-specific target that is based on progress from the baseline vaccination rate of its members. That CCO-specific target will be easier to hit than 70% because it would take into account a CCO’s individual progress from their vaccination rates in April.

The state awards incentive funding to CCOs each year based on how they perform in hitting designated targets, from diabetes monitoring to behavioral health screenings. In October, CCOs received about $160 million in incentive money for their work to hit targets in 2019.

Oregon has 16 CCOs, each one assigned to a region of the state. 

The state watered down its initial vaccination-driven incentive cash plan after CCOs complained it was unrealistic. The state initially proposed that Medicaid insurers must vaccinate at least 80% of their population age 16 and older by Dec. 31 in order to qualify for all the incentive money. Also, the state initially suggested that nearly $100 million -- almost half of the annual incentive funding expected for 2021 -- go for the COVID-19 vaccination goal.

CCOs pushed back, saying the 80% rate was unrealistic, especially in rural areas with high vaccine hesitancy with rates still well below 50%. 

As an alternative, Medicaid insurers pushed for -- and received -- a metric that would take into account each CCO’s challenges, including its starting point.

The estimated $200 million incentive money anticipated for 2021 is a small portion of the roughly $5 billion the insurers will receive for the year. But the incentive money is valued highly by the insurers because it is extra cash that they can earn, on top of the standard per-member monthly payment they receive from the state. The insurers typically share the incentive money with health care providers that work to meet the incentives.

CCOs can qualify for the vaccination reward -- or a portion of it -- in different ways. They will receive 90% of their portion of the vaccine metric dollars if they achieve a 70% vaccination rate of members age 16 and older. 

Alternatively, an insurer can qualify for 90% of their vaccine dollars if they make progress in their vaccination rate using a formula set by the state that takes the CCOs April 1 vaccination baseline. 

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1

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