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Contractors to serve 1 million Oregonians play big role in reforms, state says oversight improved.

OREGON HEALTH AUTHORITY - The state's second round of Oregon Health Plan reforms since 2012 has selected 15 regional contractors. Contracts will be finalized in October.A total of 15 companies have been chosen to deliver health care to nearly 1 million low-income Oregonians around the state, health officials announced Tuesday, July 9.

Oregon's announcement of the winners of the biggest procurement in state history ends the first chapter of the state's oft-touted 2012 Oregon Health Plan reforms — once considered a model for Medicaid programs around the country.

And it kicks off a new chapter, one in which officials say additional reforms will finally deliver the aggressive oversight that state officials promised seven years ago.

Thanks to new oversight tools, contractors will be held to a "high bar," Oregon Health Authority Director Patrick Allen said Tuesday.

In fact, four of the 15 winners were granted contracts for only one year, not for the full five years most companies got — for the first time creating a probationary status of sorts, in which companies serving the Oregon Health Plan prove they are up to the task.

Not only does the Oregon Health Plan arguably touch more lives than any other state program, it represents a huge expenditure, using what amounts to a privatized health care delivery system.

To qualify for the Oregon Health Plan's free care, individual members must earn no more than $1,396 per month, or $2,887 for a family of four.

Based on reforms spearheaded by then-Gov. John Kitzhaber seven years ago, the Oregon Health Plan uses what are called coordinated care organizations — essentially regional insurance companies — to manage care for one in four Oregonians.

The state won $1.9 billion in federal grants in exchange for vowing tough oversight, but a Portland Tribune investigation last year found that reforms had failed to cut cost growth; the state had not enforced the first round of contracts; and a state enforcement manager last year quit, citing a "complete lack of accountability" among CCOs thanks to poor state oversight.

State coffers provided more than a quarter of the Oregon Health Plan's overall spending, with the federal government providing much of the rest via the Medicaid program.

State officials plan to spend more than $5 billion on the Oregon Health Plan in 2020, and escalating amounts after that.

State winnowed applicants

The Oregon Health Policy Board, which oversees the health authority, drew up additional reforms last year, and in February the state received two dozen applications for a new round of contracting.

But many of those applicants consolidated their applications or withdrew, and on Tuesday state officials announced that they denied four applications — including three new applicants and one application from an existing care organization, Primary Health in Josephine and Jackson counties.

Competition locally

The tally of winners announced Tuesday means the map of who cares for Oregonians, and where, looks similar pretty similar to the old one — since there are 15 organizations that currently serve the program.

The biggest change in greater Portland will be competition.

Trillium Health, which currently contracts with the state to serve Oregon Health Plan members in Lane County, now will operate a care organization in Washington, Multnomah and Clackamas counties as well.

Trillium, which is owned by Centene Health, a publicly traded Fortune 500 company, will compete with Health Share of Oregon, a collaborative of local hospital systems in the region.

Health Share's previous competitor was the nonprofit Family Care Inc., but that company stopped serving Oregon Health Plan members in early 2018 after suffering huge losses and suing the state for higher reimbursement rates.

In the past, former coordinated care executives and lawmakers have criticized the state oversight system, claiming it allows finances to be manipulated to show profit or loss.

This year in the Legislature, lawmakers approved a variety of reforms in Senate Bill 1041, which will allow in-depth examinations of care organization practices, much as the state already does for insurance companies in the private market.

Sidebar

Breaking it down

State awards 15 contracts among 19 applicants:

(Applicant; contract status; proposed service area)

1. AllCare CCO Inc.

1 year

Josephine, Jackson, Curry and partial Douglas

2. Cascade Health Alliance LLC

1 year

Partial Klamath

3. Columbia Pacific CCO LLC

5 years

Clatsop, Columbia and Tillamook

4. Eastern Oregon Coordinated Care Organization LLC

5 years

Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler

5. Health Share of Oregon

5 years

Clackamas, Multnomah and Washington

6. InterCommunity Health Plans dba InterCommunity Health Network Coordinated Care Organization

5 years

Linn, Benton and Lincoln

7. Jackson County CCO dba Jackson Care Connect

5 years

Jackson

8. Marion Polk Coordinated Care

DENIED

Marion, Polk, partial Benton, Linn, Clackamas and Yamhill

9. Northwest Coordinated Care Organization LLC (Moda Health Plan Inc.)

DENIED

Clatsop, Columbia and Tillamook

10. West Central Coordinated Care Organization LLC (Moda Health Plan Inc.)

DENIED

Lane

11. PacificSource Community Solutions - Central Oregon

5 years

Deschutes, Jefferson, Crook and partial Klamath

12. PacificSource Community Solutions - Columbia Gorge

5 years

Hood River and Wasco

13. PacificSource Community Solutions - Lane County

5 years

Lane

14. PacificSource Community Solutions - Marion and Polk Counties

5 years

Marion and Polk

15. Primary Health

DENIED

Josephine, Jackson and partial Douglas

16. Trillium Community Health Plan Inc.

5 years

Lane, Washington, Multnomah, Clackamas, partial Douglas and Linn

17. Umpqua Health Alliance LLC

1 year partial

Douglas

18 Western Oregon Advanced Health LLC — Advanced Health

5 years

Coos and Curry

19. Yamhill County Care Organization

1 year

Yamhill, partial Polk and Washington


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