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.
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.
Breaking it down
State awards 15 contracts among 19 applicants:
(Applicant; contract status; proposed service area)
1. AllCare CCO Inc.
Josephine, Jackson, Curry and partial Douglas
2. Cascade Health Alliance LLC
3. Columbia Pacific CCO LLC
Clatsop, Columbia and Tillamook
4. Eastern Oregon Coordinated Care Organization LLC
Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler
5. Health Share of Oregon
Clackamas, Multnomah and Washington
6. InterCommunity Health Plans dba InterCommunity Health Network Coordinated Care Organization
Linn, Benton and Lincoln
7. Jackson County CCO dba Jackson Care Connect
8. Marion Polk Coordinated Care
Marion, Polk, partial Benton, Linn, Clackamas and Yamhill
9. Northwest Coordinated Care Organization LLC (Moda Health Plan Inc.)
Clatsop, Columbia and Tillamook
10. West Central Coordinated Care Organization LLC (Moda Health Plan Inc.)
11. PacificSource Community Solutions - Central Oregon
Deschutes, Jefferson, Crook and partial Klamath
12. PacificSource Community Solutions - Columbia Gorge
Hood River and Wasco
13. PacificSource Community Solutions - Lane County
14. PacificSource Community Solutions - Marion and Polk Counties
Marion and Polk
15. Primary Health
Josephine, Jackson and partial Douglas
16. Trillium Community Health Plan Inc.
Lane, Washington, Multnomah, Clackamas, partial Douglas and Linn
17. Umpqua Health Alliance LLC
1 year partial
18 Western Oregon Advanced Health LLC — Advanced Health
Coos and Curry
19. Yamhill County Care Organization
Yamhill, partial Polk and Washington
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