As part of my ongoing effort to inform regarding health care coverage for us here in Oregon, I wanted to share some news from the Oregon Health Authority.
They announced this week they have received 24 "letters of intent" from Coordinated Care Organizations to apply for potential contracts with counties statewide. This would be for a period between 2020-2024. (see table below).
What does this mean for consumers?
As you may or may not know, almost all of the health care delivery to those with the Oregon Health Plan (Medicaid) and frequently also Medicare/Medicare Advantage, was distributed for management by a number of different CCO's across the state after an administrative change in 2012. Excepting OHP Open Card members and those with Tribal affiliations, everyone in Oregon has been moved into health care coverage that's directly overseen by one of these CCO's- meaning they determine what benefits individuals get, whether you need to pay a co-pay to see a provider, types of coverage available for different types of health care issues, and limitations or exclusions on what would be covered.
According to the OHA, "CCOs bring together physical, behavioral, and oral health providers to coordinate care for people on the Oregon Health Plan. They improve health and reduce costs by providing more coordinated, flexible and innovative services."
The down side to CCO management, however, falls on those who live outside of the heavily populated urban centers in Oregon. Those who live in rural areas, such as much of Eastern Oregon, here in Lane County outside of Eugene, and other areas in Central or Southern Oregon, have only been provided one CCO to manage the entire county. (why this is so is based on the complexities of how insurance systems and legislation work in the U.S.- perhaps a good topic for a separate blog post.)
The problem with having only one CCO in charge of the health care for the majority of users in a county (and let's face it, many of the more rural areas in Oregon are also the ones with the most people living at or below Medicaid's income criteria), lies in choice. Need a vision exam? Sorry, Trillium only covers vision services for severe or degenerative eye diseases. Need to get a certain test or get durable medical equipment (such as a CPAP machine) covered? Only if your CCO says it's allowed. Or, you can move to Portland or Salem, where you can shop around for CCO's who are better-resourced, or are at least more willing to cover certain services.
So the introduction of more CCO's throwing their hat into the ring for the upcoming contract period is, we can hope, a good thing. It will potentially provide at least two choices in a number of under-served counties, rather than one. This will, hopefully, provide some better alternatives to consumers, and encourage some healthy competition/avenues for consumer feedback, in the hopes of attracting new customers. It's also reassuring that most of the CCO's already in operation are staying, and in some cases expanding their reach, rather than pulling out of Oregon.
As far as whether continuing to operate primarily under the CCO model is a good idea by itself...? Well, I guess we will have to let the future decide.
Letters of intent received by the Oregon Health Authority for CCO 2.0 contracts
| Organization | Service Area |
| AllCare CCO, Inc. | Josephine, Jackson, Curry and partial Douglas |
| CareOregon, Inc. | Clackamas, Multnomah, Washington |
| Cascade Health Alliance | partial Klamath |
| Columbia Pacific CCO, LLC | Clatsop, Columbia and Tillamook |
| Eastern Oregon Coordinated Care Organization, LLC | Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, Wheeler |
| Health Share of Oregon | Clackamas, Multnomah, Washington |
| InterCommunity Health Network | Linn, Benton, Lincoln |
| Jackson County CCO | Jackson |
| Kaiser Foundation Health Plan of the Northwest | Clackamas, Multnomah, Washington |
| Marion Polk Coordinated Care | Marion, Polk and partial Benton, Linn, Clackamas and Yamhill |
| Moda Health Plan, Inc. | Clatsop, Columbia and Tillamook |
| Moda Health Plan, Inc. | Clackamas, Multnomah, Washington |
| Moda Health Plan, Inc. | Lane |
| PacificSource Community Solutions - Central Oregon | Deschutes, Jefferson, Crook, partial Klamath |
| PacificSource Community Solutions - Columbia Gorge | Hood River, Wasco, Sherman, Gilliam, Wheeler |
| PacificSource Community Solutions - Lane | Lane |
| PacificSource Community Solutions - Marion Polk | Marion and Polk |
| PacificSource Community Solutions - Portland | Clackamas, Multnomah, Washington |
| PrimaryHealth of Josephine County | Josephine, Jackson and partial Douglas |
| Providence Health Assurance | Multnomah, Washington, Clackamas, Hood River, Clatsop, Jackson |
| Trillium Community Health Plan, Inc. | Lane, partial in Benton, Linn, Coos and Douglas |
| Umpqua Health Alliance, LLC | Douglas and Lane |
| Western Oregon Advanced Health, LLC | Coos and Curry |
| Yamhill County Care Organization | Yamhill and partial Clackamas, Marion, Polk, Tillamook and Washington |
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