November 8, 2018
As the Oregon Health Authority (OHA) works to develop contracts for the next five years of the Oregon Health Plan (OHP) and coordinated care, the agency is seeking public comment on member enrollment, the risk adjustment process, and rate setting methodology.
OHA is using a request for application or RFA process to award coordinated care organization (CCO) contracts for 2020-2024. In an RFA, all qualified candidates are awarded a contract, meaning there is not a target number of coordinated care organizations (CCOs) the state is aiming to contract with. Because OHA has not set a target number of CCOs, members may find multiple CCOs serving their area where previously only one was available. Similarly, members currently enrolled in a CCO may find that their CCO has not applied for or been awarded a contract during the 2020 cycle.
Potential changes in CCO membership affect capitation rates paid to CCOs (which is the amount paid to CCOs per member per month), and potentially the CCO’s risk profile. The risk profile changes may result in a CCO having a different mix of members with different diseases, which would result in higher needs or lower needs depending on the changes.
The combination of an unknown number of CCOs and the potential for shifts in membership between CCOs means that OHA must develop an approach for member enrollment and rate development that takes these scenarios into consideration.
Values guiding OHA’s decision-making include: maintaining continuity of care for OHP members, allowing member choice, equitable opportunity for procurement, and CCO financial viability.
OHA will discuss why an enrollment policy is needed for CCO 2.0 and the factors affecting member enrollment and will seek public comment on the approach currently under consideration to address multiple procurement scenarios.
This approach includes offering open enrollment in areas of the state where there is a change in CCO availability and adjusting the auto-assignment process for members who do not select a plan when multiple plans exist in their service area.
Risk adjustment and rate setting
OHA will seek public comment on how to set capitation rates used to build global budgets for the new contracts that meet actuarial requirements and achieve the goal of a sustainable rate of growth. OHA will share draft rate methodology adjustments to the current rate development process.
OHA also will share how it aims to apply health-based risk adjustment to the CCO capitation rates in a fair manner when shifts in membership occur. The approach currently under consideration is a risk corridor option. A risk corridor protects the CCO and OHA from over- and under-paying for services when membership changes.
What: OHA public meeting to seek public comment on member enrollment approaches, rates and risk adjustment for the 2020-2024 CCO contracts
When: Monday, November 19, 8-11 a.m.
Where: Department of Consumer and Business Services meeting room 260, Labor and Industries Building, 350 Winter St NE, Salem
The public can also join remotely through a telephone conference line at 888-251-2909, participant code 2450162; or by joining a live-stream of the meeting.
Public comment: Public comment will be taken at specified times during the meeting. Those unable to attend the meeting can submit public comment to OHA at CCO2.email@example.com until November 28.
- 8-9 a.m.: Welcome; presentation of member enrollment approach; public comment
- 9-11 a.m.: Presentation of rate and risk adjustment approaches; public comment; adjourn
OHA will post supplemental materials for the meeting on November 14 on the CCO 2.0 page on the OHA website.
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