The Oregon Health Association has deemed Coordinated Care Organizations (CCO) to be the best solution to improved health and out-of-control medical costs, according to a report released Monday.

In 2012, the agency set goals to improve health, reduce waste and costs, create local accountability, maintain sustainable spending and coordinate care, among others.

Three years later, it seems to be working, OHA reports.

According to the Future of the Oregon Health Plan released this week, 13 percent of those involved in CCOs report being healthier — up from from 59 percent in 2011 to 72 percent in 2015 — avoidable emergency room use was down by half, and taxpayers saved $2.2 billion.

Additionally, with the expansion of the Affordable Care Act, the number of uninsured residents dropped from 14.6 percent in 2013 to 6.2 percent in 2017, while 26 percent of people qualified to join the Oregon Health Plan, representing an increase of almost 100 percent.

“The nation spent $3.3 trillion on health care in 2016, or more than $10,000 per person,” the report reads. “We have reduced the growth of Medicaid spending in Oregon, but there’s more work to do.”

For many without health insurance, that list is not news.

It notes health care is still unaffordable to many, disparities exist, prescription drug prices keep rising and people are still mostly paying for quantity rather than quality. Pharmacy expenditures alone have gone from just over $20 billion in 2011 to almost $40 billion in 2016.

Which CCOs?

After an Oregon Health Public Broadcasting “listening tour” in 2017 and two public input meetings this year, OHA hopes to have selected certain CCOS by mid-2019 and have contracts signed by the early part of 2020.

Only CCOs and other companies currently operating in Oregon will be eligible to apply; the most visible in this area are Medford-based AllCare and Coos Bay-based Advanced Health.

The health authority also conducted a survey of 1,000 people, with 928, or 61.8 percent, saying behavioral health care — mental health and addiction services — should be the top priority. That was followed by “social determinants of health” and “care coordination.”

Social determinants run the gamut, according to Advanced Health CCO representatives. Some include homelessness, education, employment and incarceration — all elements that can contribute to poor health.

Care coordination, deemed by almost half the survey respondents to be a top priority, is when a physician knows a patient is also undergoing other kinds of treatment — from counseling to acupuncture — for other conditions and can readily assist in their holistic treatment.

Health disparities was deemed the fourth most important need to address, with just less than 200 people naming it as a top priority, but 551 of the 1,000 surveyed saying it ranked in the top three.

Ranked slightly lower was health information technology and exchange — allowing physicians to more easily discuss a patient’s situation with other health care providers — oral health care, “value-based” payments, primary care, speciality care and children’s health.

Five big ideas

OHA has outlined “five big ideas” to improve coordinated care in Oregon: improving behavioral health, addressing the social factors that affect health, reducing health care costs, paying for better health and strengthening transparency and accountability.

To improve behavioral health would specifically require CCOs to ensure members have immediate access to mental health and addiction services without having to navigate the system on their own, the report reads.

That could include setting targets for better outcomes, such has having no children in the emergency room due to a mental health crisis; paying for “warm handoffs” between physical and mental health providers; and requiring CCOs to offer state health plan members more provider choices.

That could result in better health and prompt CCOs to craft innovative ideas related to behavioral health, the report reads. But providers should also note savings won’t be immediate and a lack of providers in many areas might make it hard to meet the goals.

The second big idea is to help OHP members with housing, food insecurity, transportation to ease stress in everyday life to promote good health.

That might involve CCOs spending a larger portion of their budgets on social health — say, hiring a housing case manager at a local nonprofit — requiring them to increase the use of peer support specialists and doulas, mandating them to dedicate resources to improve health equity and working with non-profit hospitals, local health departments and other CCOs.

“However, some communities might have fewer social service providers with whom to partner,” the report reads, “and spending more money on social factors could mean less money for other services.”

Another goal of OHA is to keep the health plan’s costs in line with overall cost-of-living increases by setting lower spending targets, giving CCOs more financial rewards to improve health and save money, and helping them purchase less expensive drugs.

The United States, the report notes, has the highest health expenditures per capita than 11 other comparable countries — and double the average cost. Some of those countries include the U.K., Japan, Belgium, Sweden, Australia and Canada.

Again, however, “some CCOs might not be able to remain financially strong, which could disrupt member care,” the report reads. “And doctors and other providers could get paid lower rates and choose not to work with CCOs, and the state has limited ability to reduce the cost of medicine.”

“Value-based” payments — health care providers being paid for improving health and reduce costs, rather than the number of visits or services provided — could involve setting a target, with 70 percent of CCO payments being based on that goal by 2024. It also might require CCOs to make those payments to certain primary care clinics and could have CCOs work with public employee and commercial health insurance plans to expand payments in all markets.

That could result in better health scenarios and quality of care for OHP members, a more efficient health care system and reduce health care costs, the report reads. But it would mean a big adjustment for providers, some of whom lack the tools and systems needed to measure and report “quality,” the report reads. And there is no guarantee that better health in a community will lower overall costs.

To ensure CCOs are more accountable might require them to have two community representatives on their boards, require advisory committees to reflect the demographics of the community they serve and make cost, quality and payment data available to the public.

In turn, that could provide better community representation in CCO oversight and information about how money is spent.

The full report can be viewed at https://health.Oregon.gov.

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