Since 2012, the Oregon Health Authority has been working on the transition to a Coordinated Care Organization model, measuring performance along the way. Although 2013 was the first full year of operation, the data shows there’s still much to work ahead.
Primary care visits have increased and emergency room visits have decreased, and the percentage of patients reporting they were able to access care did increase from 83 percent in 2011 to 84 percent in 2013.
However, only five Coordinated Care Organizations met the benchmark of 87 percent and received medical appointments and care when necessary, based on survey results – Western Oregon Advanced Health, PrimaryHealth of Josephine County, Jackson Care Connect, Columbia Pacific and Intercommunity Health Network.
Overall, adult access to care decreased slightly from 2011 to 2013, while child access improved slightly among all the CCOs.
As an extra added bonus, a quality pool was developed by the Health Authority, which held back 2 percent of their monthly payments, and put all of them into a common quality pool. To earn full payment or even more money, CCOs had to meet at least 12 of 17 improvement targets, and have at least 60 percent of their members enrolled in a patient-centered primary care home. This was the first time quality measures have been used to distribute funds.
All told, the 15 CCOs received $47 million with HealthShare leading the way with $13.7 million, followed by Trillium Health Alliance and Willamette Valley Community Health, with $5 million each, FamilyCare, $4.3 million, Intercommunity Health Network, $2.7 million and All Care Health Plan, $2.2 million.
PrimaryHealth Performed Well
PrimaryHealth of Josephine County was among the few CCOs that managed to meet the patient access benchmark, moving from 83 percent in 2011 to 88 percent in 2013.
Jennifer Johnstun, its director of quality improvement said the quality data is important, but can be hard to apply. “It’s hard because only a sampling of your membership is called. So the results depend on who they contact, and who is willing to respond to this long survey.”
As to why PrimaryHealth managed to improve their score and even exceed the benchmark, Johnstun credited their healthcare providers. “We are the smallest CCO,” and had just 5,957 members in December 2013. “We have a provider panel that are very dedicated and really like to see their own patients. If their patients call and are having an issues, they’ll try to get them in. That commitment to continuity of care and providing the right care in the right place is definitely there.”
Additionally, PrimaryHealth clinics made a concerted effort to increase access to walk-in services. “Two of our largest clinics,” said Johnstun, “have acute care walk-in services. One of those opened in December of 2012. I think it made a huge difference in access to care for 25-30 percent of people who suddenly had access to non-ER services they never had before.”
Its work paid off. PrimaryHealth met 13 of 17 overall improvement benchmarks and received $1,024,938 from the quality pool, giving them 102 percent of the allocated funds.
Columbia Pacific Rewards Clinics
Columbia Pacific which had 14,413 members also reached the patient access benchmark, increasing from 83 percent to 87 percent. In an email statement, its regional executive Mimi Haley told The Lund Report, “Given the time period we are talking about, I suspect the biggest reason for Columbia Pacific CCO is that in late 2012, approximately 6,000 OHP eligible transitioned from open card to our CCO. They likely experienced much greater support under the CCO, by getting assigned to clinics and being supported in their engagement with providers through many of our outreach efforts. For example, we worked with the Columbia Pacific clinics to implement outreach strategies for population health management: contacting patients to ensure they were receiving appropriate preventive health screenings as one example.”
Columbia Pacific met 13.8 of the 17 overall improvement benchmarks and received $1,461,310 from the quality pool, bringing them to 104 percent of the funds.
After administrative expenses, Haley said all those dollars have been sent back to the clinics. “A portion was provided as thanks for helping achieve the 2013 metrics, and the rest was given as an investment for clinic infrastructure to be able to continue to meet metrics,” she wrote.
Yamhill Numbers Misleading
Yamhill CCO, with 13,368 members serving Yamhill County and parts of Marion, Clackamas and Polk counties, witnessed a decline in approval numbers, from 83 percent in 2011 down to 81.6 percent in 2013. However, that’s probably due to the fact that Yamhill is a new organization formed at the end of 2012, said Jim Rickards, health strategy officer.
“I’m not sure what those numbers were measuring” in 2011, he said. “We were a new organization” in 2013. Our members were trying to figure out how to access, and it takes time to build up familiarity. Some members were just getting assigned primary care providers for the first time in their lives.”
About 60 percent of Yamhill’s members were previously open card or fee for service. “So,” said Rickards, “the fact now that we had a dramatic increase in the managed population was a huge shift.”
These numbers may indicate a growing need overall, said Rickards. “They maybe highlight that in the U.S. in general, there’s a need to expand access. In Yamhill, we identified eight areas to spend expansion funds, including hiring of additional providers in the community, expanding clinic access, improving team-based care, and hiring and placement of behaviorists to take some of the burden off primary providers of handling mental health and behavioral health issues.”
Despite the patient access decline, Yamhill met 14.8 of the 17 overall improvement benchmarks, and received $1,137,005 from the quality pool, bringing them to 105 percent of funds allocated.
Yamhill intends to put these dollars back into its infrastructure, said Rickards. “A decision was made to distribute the funds between clinics in appreciation for meeting the metrics as well as to set aside a portion of the funds to support clinics in their efforts to continue to meet the metrics. This decision was made, and a distribution model was developed jointly by the clinical advisory panel, financial subcommittee and board.”
HealthShare Takes Largest Share
HealthShare of Oregon had a December 2013 enrollment of 148,201, more than twice the enrollment of the next-largest CCO. It also experienced a decline in the survey, dropping from 83 percent in 2011 to 80.2 percent in 2013.
In an email statement, Beth Sorenson, communications manager, said that “Health Share of Oregon continually monitors and tracks member satisfaction and access to care in a number of ways, and we are always looking to improve both. All of our enrolled members are assigned to primary care homes within 30 days, and our data indicates that most enrollees are being seen on a timely basis. If a member has concerns about their access to care, our customer service department works one-on-one with them to help them get the care they need, when and where they need it.”
Health Share met 12.8 of 17 overall improvement benchmarks, and has such a large enrollment that they received $13,720,133 from the quality pool, bringing them to 104 percent of funds allocated.
Those funds were distributed to its partner organizations based on performance, according to Sorenson.
PacificSource Numbers Decline
In Central Oregon, PacificSource Community Solutions CCO declined from 81 percent in 2011 to 80.6 percent in 2013. Although it didn’t meet the benchmark, Lindsey Hopper, executive director of the Central Oregon Health Council, said the goal is realistic and one that CCOs can reach.
“Our numbers for PacificSource are interesting,” said Hopper, because in 2013 the CCO covered a much larger territory. Their December 2013 enrollment was 36,667. “We are excited to see what the numbers looks like for 2014 because it’ll be just our area. We don’t know how it will break out, but the information will be very useful to us.”
The 2014 figures will also include the expansion population, and Hopper is very interested in seeing results from “a lot of folks who have never had insurance before, and are used to going to the ER instead of primary care. It will be interesting to see.”
As far as the numbers are concerned, “As one piece of a whole picture, it is one patient’s experience at a point in time,” she said. “We also look at what providers are reporting for wait times, Saturday access, transportation, hospital readmission rates. A person’s experience with access could be very different in Prineville than in Bend. In Crook County after 5 pm, there’s nothing for you other than going to the ER.”
Along with increasing the number of providers in the area, PacificSource is also reviewing how many members have to leave the area for specialty services, said Hopper,” to better know which specialties we may want to amp up here.” The CCO is also in the process of accrediting school-based health centers, “which will be important for caring for the adolescent population.”
Cascade Health Alliance was also contacted, but did not reply to requests for comment.
Patient access data was measured by the Consumer Assessment of Healthcare Providers and Systems, a program is funded and overseen by the U.S. Agency for Healthcare Research and Quality, which works closely with a consortium of public and private research organizations. The surveys ask consumers and patients to report on and evaluate their healthcare experiences.
Although patient surveys are subjective, CAHPS results provide important information about how patients feel about the care they receive and access to it. The benchmark was set by the Oregon Health Authority’s Metrics and Scoring Committee. According to OHA’s Alissa Robbins, the benchmark for access to care was developed from the national Medicaid benchmark, creating an average from the national adult and national child 75th percentiles.
“Benchmarks were set to be a challenge,” Robbins said in a statement, “and we were pleased to see a small increase statewide. We know there is still more progress to be made and we will continue to support CCOs as they work to improve effective and timely access to care.”
FOR MORE INFORMATION
To look at the full list of CCOs, their patient access data and their quality pool funds, click here. www.oregon.gov/oha2013PerformanceReport
Temple can be reached at [email protected]
