Oregon has implemented a statewide accountable care model with the 2012 launch of Coordinated Care Organizations (CCOs). CCOs are partnerships of payers, providers, and community organizations that work at the community level to provide coordinated health care for children and adult Oregon Health Plan Enrollees. CCOs build on pre-existing initiatives in the state including the Patient-Centered Primary Care Home (PCPCH) Program created in 2009 to enhance primary care across the state by encouraging practices to adopt the medical home model.
A PCPCH Pediatric Standards Advisory Committee was involved in the creation of the program to ensure the use of appropriate measures for children. Participating practices are required to uphold medical home standards related to areas such as access to care, accountability, and coordination and integration. Oregon also has an approved state plan amendment to implement Health Homes that build on the PCPCH program and provide services to Medicaid enrollees with chronic conditions.
Currently, there are 6,618 primary care practitioners participating in CCOs. Of those, 3,823 (58%) are pediatric clinicians. Over 400,000 clients under the age of 19 have had an encounter with a CCO during 2013.
Sixteen CCOs operate across Oregon and each is provided with a fixed global budget from the state. This financing strategy gives CCOs the flexibility to create alternative payment methodologies for providers and to explore innovative strategies to support transformation based on the needs within their specific communities. CCOs are required to implement the requirements for the Patient-Centered Primary Care Home program as much as possible, and, in addition to providing physical health care, CCOs also deliver mental health, alcohol/substance abuse, and dental care services. Furthermore, CCOs are expected to coordinate with their local Early Learning Hub, newly launched community entities charged with supporting efforts for education and early childhood development.
Oregon received a State Innovation Model (SIM) testing grant from the Center for Medicare and Medicaid Innovation in 2013. A key focus of the SIM grant, is to support the improvement and spread of the payment model used by CCOs to other payers beyond Medicaid and to create a Transformation Center to support the improvement and testing of the CCOs. The Center provides technical assistance and offers CCOs the opportunity to participate in learning collaboratives focusing on a variety of issues such as CCO incentive measures and complex care initiatives.