Report Details CCO Progress as Oregon Health Authority Seeks to Improve Care, Limit Spending

Oregon’s effort to overhaul its healthcare system – with coordinated care organizations leading the charge – is beginning to show results, according to an assessment of CCOs and other Oregon Health Authority data that was submitted to the Legislature when makers convened in Salem. But no CCO yet meets all the state’s goals, and complaints about these healthcare groups have been climbing steadily, the report found.

Primary Health and the plans run by PacificSource landed near the top of several metrics, while FamilyCare often outshone Health Share and Trilllium regularly fell closer to the bottom

The latest release of "Oregon's Health System Quarterly Legislative Report” comes five months after the Oregon Health Authority’s first-quarter 2016 report, and the agency appears to be playing catch-up, including comprehensive data from the second quarter of last year (April through June), plus data on the third quarter where available (July through September).

The report includes a look at financial data already examined by The Lund Report. Click here to review our analysis of CCO finances. But the document also delves into CCO performance to a degree not previously examined.

CCO Performance

The state’s 16 CCOs are in their fourth year attempting to use data to track their efforts to improve healthcare outcomes while saving money. Meeting minimum benchmarks, or demonstrating improvement, can qualify a CCO for a financial bonus.

For example, the Oregon Health Authority measures emergency department visits to assess how well CCOs catch and treat health concerns before members require emergency care. A CCO scoring below 39.8 emergency department visits per month for every 1,000 members meets the state’s benchmark for financial reward – an achievement accomplished by only five CCOs.

Here’s how the state’s CCOs ranked on emergency department utilization, from best to worst, in the second quarter of 2016 – a lower score is better:

1. Pacific Source of Central Oregon – 31.2 emergency department visits per 1,000 member months
2. PrimaryHealth of Josephine County – 32.9 emergency department visits per 1,000 member months
3. AllCare – 39.0 emergency department visits per 1,000 member months
4. Western Oregon Advanced Health – 39.2 emergency department visits per 1,000 member months
5. Cascade CCO – 39.5 emergency department visits per 1,000 member months
6. FamilyCare – 41.0 emergency department visits per 1,000 member months
7. PacificSource of the Gorge – 41.4 emergency department visits per 1,000 member months
8. Willamette Valley Community Health – 45.1 emergency department visits per 1,000 member months
9. Jackson Care Connect – 45.3 emergency department visits per 1,000 member months
10. Columbia Pacific – 45.9 emergency department visits per 1,000 member months
11. Trillium – 47.1 emergency department visits per 1,000 member months
12. Health Share of Oregon – 47.9 emergency department visits per 1,000 member months
13. InterCommunity Health Network – 50.3 emergency department visits per 1,000 member months
14. Eastern Oregon CCO – 54.5 emergency department visits per 1,000 member months
15. Umpqua Health Alliance – 59.7 emergency department visits per 1,000 member months
16. Yamhill County CCO – 63.6 emergency department visits per 1,000 member months

Only the top five – PacificSource of Central Oregon, PrimaryHealth, AllCare, Western Oregon Advanced Health, and Cascade CCO – met statewide benchmarks for keeping emergency department visits down.

On a mental health related metric, six CCOs achieved the statewide benchmark, which set a goal of following up with 79.9 percent of patients after hospitalization for mental illness. Here’s how they ranked:

1. PrimaryHealth of Josephine County – 95.2 percent of patients received follow-up after hospitalization for mental illness
2. PacificSource of the Gorge – 90.9 percent received this follow-up
3. Cascade CCO – 87.5 percent received this follow-up
4. PacificSource of Central Oregon – 82.2 percent received this follow-up
5. Western Oregon Advanced Health – 80.2 percent received this follow-up
6. AllCare – 79.9 percent received this follow-up
7. Health Share of Oregon – 79.7 percent received this follow-up
8. Yamhill County CCO – 78 percent received this follow-up
9. Umpqua Health Alliance – 76.9 percent received this follow-up
10. Eastern Oregon CCO – 76.3 percent received this follow-up
11. Jackson Care Connect – 75.9 percent received this follow-up
12. Columbia Pacific – 75.8 percent received this follow-up
13. Willamette Valley Community Health – 74.6 percent received this follow-up
14. InterCommunity Health Network – 72.1 percent received this follow-up
15. FamilyCare – 70.8 percent received this follow-up
16. Trillium – 63.3 percent received this follow-up

PrimaryHealth of Josephine County, PacificSource of the Gorge, Cascade CCO, PacificSource of Central Oregon, Western Oregon Advanced Health and AllCare all met the statewide benchmark

In addition to breaking out the individual performance of CCOs, the Oregon Health Authority’s analysis looks at how well different demographic groups were served statewide.

Across all CCOs, for example, African American members were most likely to use the emergency department than members of other races, with Asian Americans least likely. In the second quarter of last year:

• For every 1,000 black CCO member in Oregon, 66 used an emergency department each month.
• For every 1,000 American Indian or Alaska Native CCO members, 58 used an emergency department each month
• For every 1,000 white CCO members, 50.5 used an emergency department each month
• For every 1,000 Hawaiian or Pacific Islander CCO members, 40.9 used an emergency department each month.
• For every 1,000 Asian American CCO members, 21.2 used an emergency department each month.

The same metric also showed a gender disparity – with 50.1 of every 1,000 women using the emergency department each month, compared to 40.7 of every 1,000 men.

CCO Member Satisfaction

Though benchmark data for CCOs only covers the second quarter of 2016, the Oregon Health Authority’s report includes member satisfaction data through the third quarter. The results show that complaints against CCOs have been climbing steadily since tracking began, from 3.1 complaints or grievances per 1,000 members in Q2 2015, up to 4.9 complaints or grievances per 1,000 members in Q3 2016.

The Oregon Health Authority attributes this increase to a change in CCO reporting processes, and notes that 99 percent were resolved within the quarter.

Here’s how the state’s CCOs ranked on complaints in the third quarter of 2016, from fewest to most:

1. Cascade CCO – 1.0 complaints per 1,000 members
2. Eastern Oregon – 1.0 complaints per 1,000 members
3. InterCommunity Health Network – 1.0 complaints per 1,000 members
4. PacificSource of the Gorge – 1.2 complaints per 1,000 members
5. AllCare – 1.3 complaints per 1,000 members
6. Umpqua CCO – 1.4 complaints per 1,000 members
7. PacificSource of Central Oregon – 2.5 complaints per 1,000 members
8. FamilyCare – 2.7 complaints per 1,000 members
9. Columbia Pacific CCO – 2.9 complaints per 1,000 members
10. PrimaryHealth of Josephine County – 3.3 complaints per 1,000 members
11. Yamhill CCO – 3.4 complaints per 1,000 members
12. Trillium – 3.7 complaints per 1,000 members
13. Jackson Care Connect – 4.7 complaints per 1,000 members
14. Willamette Valley Community Health – 6.5 complaints per 1,000 members
15. Health Share – 7.5 complaints per 1,000 members
16. Western Oregon Advanced Health – 13.8 complaints per 1,000 members

Patient-Centered Primary Care

Oregon’s attempt to improve health and lower healthcare spending centers in large part on efforts to coordinate healthcare via primary care providers.

About two-thirds of primary care clinics in the state – 640 in all – have been certified as patient-centered primary care homes. Seven practices have received a 3 star designation for advancing this model:

Childhood Health Associates of Salem; Grants Pass Clinic; Winding Waters Clinic; and Metropolitan Pediatrics of Portland, Gresham, Westside, and Happy Valley.

In addition, the state’s CCOs have been working to enroll their members in patient-centered primary care homes – with 13 of the 16 also participating in a fledging program called Comprehensive Primary Care Plus. Click here to read about the CPC+ pilot in Oregon.

Cascade CCO, InterCommunity Health Network and Trillium are the CCOs not participating in CPC+, but the data shows that they are still heavily focused on enrolling members in patient-centered primary care.

Here’s how the state’s CCOs rank on this metric, as of September 2016:

1. PacificSource of the Gorge – 100 percent of members enrolled in patient-centered primary care homes
2. PrimaryHealth of Josephine County – 100 percent of members enrolled in patient-centered primary care homes
3. Umpqua CCO – 96.5 percent of members enrolled in patient-centered primary care homes
4. Willamette Valley Community Health – 95.4 percent of members enrolled in patient-centered primary care homes
5. FamilyCare – 93.7 percent of members enrolled in patient-centered primary care homes
6. PacificSource of Central Oregon – 93.2 percent of members enrolled in patient-centered primary care homes
7. InterCommunity Health Network – 93.0 percent of members enrolled in patient-centered primary care homes
8. Health Share – 92.9 percent of members enrolled in patient-centered primary care homes
9. Columbia Pacific– 91.7 percent of members enrolled in patient-centered primary care homes
10. Western Oregon Advanced Health – 88.2 percent of members enrolled in patient-centered primary care homes
11. AllCare – 85.9 percent of members enrolled in patient-centered primary care homes
12. Eastern Oregon CCO – 84.2 percent of members enrolled in patient-centered primary care homes
13. Cascade CCO – 83.3 percent of members enrolled in patient-centered primary care homes
14. Trillium – 83.3 percent of members enrolled in patient-centered primary care homes
15. Yamhill CCO – 80.1 percent of members enrolled in patient-centered primary care homes
16. Jackson Care Connect – 77.4 percent of members enrolled in patient-centered primary care homes

According to a Portland State University analysis, for every $1 increase in primary care spending in a patient-centered primary care home, $13 of other spending is prevented – with specialty care, emergency department visits and other health needs reduced. By that formula, the Oregon Health Authority estimates that patient-centered primary care homes have saved the state’s health system $240 million over the past three years.

Reach Courtney Sherwood at [email protected]. Follow her on Twitter at @csherwood