September 17, 2020
Oregon coordinated care organizations (CCOs) continue to work on health system transformation by focusing on better care and better health outcomes while controlling health care costs. The 2019 CCO Metrics Report shares the results of Oregon’s pay-for-performance quality incentive program. To earn their full incentive payment, CCOs must meet benchmarks or improvement targets on at least 12 of the 16 measures, achieve a performance goal related to enrollment in patient-centered primary care homes, and report data for two electronic health records metrics.
"Oregon’s quality incentive program continues to play a key role in improving health outcomes and the care received by our more than 1 million members," said Jeremy Vandehey, OHA's director of health policy and analytics. "As individuals and families begin to re-engage with the health system after the significant disruption caused by COVID-19, these quality measures will help us see how effective CCOs are in connecting people to the care they need during challenging times."
The report includes three new measures: oral evaluation for adults with diabetes; preventive dental services; and well child visits in the third, fourth, fifth and sixth years of life. Preventive dental care and well child visits are part of a multi-year strategy focused on the health sector’s role in preparing children for kindergarten.
For the 2021 measurement year, the Metrics and Scoring Committee added a new measure focused specifically on health equity: Meaningful language access to culturally responsive health care services.
- The percentage of children in foster care who received timely mental, physical and dental health assessments has improved by more than 200 percent since 2014.
- Cigarette smoking prevalence declined among 13 of 15 CCOs in 2019. The overall smoking prevalence among CCO members decreased by nearly 9 percent.
- Emergency department utilization among members with mental illness was first included in the Quality Incentive Program in 2018. In 2019, nine of 15 CCOs improved, and seven achieved their improvement target.
Additionally, 2019 was the first year postpartum care was included in the Quality Incentive Program. All but two CCOs achieved the benchmark or improvement target. This was also the first year timeliness of prenatal care was no longer an incentive measure. Statewide performance on this measure dropped by 12 percentage points, and no CCOs demonstrated improvement on the rate of women receiving timely prenatal care.
The quality pool model rewards CCOs for the quality of care provided to Oregon Health Plan members. This model increasingly rewards CCOs for outcomes, rather than utilization of services, and is one of several key health system transformation mechanisms for achieving Oregon’s vision for better health, better care and lower costs.
The quality pool comprised 4.25 percent of CCOs’ monthly payments in 2019, for a total of more than $166 million. While all CCOs showed improvement on a majority of measures, five out of 15 earned 100 percent of their quality pool dollars. Six CCOs met 11 of the benchmarked measures and 80 percent of their quality pool, and four CCOs earned 60 percent. This left nearly $46 million for the challenge pool. The challenge pool was distributed to CCOs that met the benchmark or improvement target on four measures that impact early childhood: assessments for children in ODHS custody, childhood immunization status, developmental screenings in the first 36 months of life and timeliness of postpartum care.
Changes to the program due to COVID-19
Early in the COVID-19 emergency, OHA evaluated sources of funding that could be released quickly to support CCOs and members during the emergency. Sixty percent of the 2019 quality pool dollars were distributed to CCOs in April, with the remaining balance released to CCOs in June based on the performance described in this report.
Due to the COVID-19 pandemic and related disruption to the health care system, the Metrics and Scoring Committee elected to modify the design of Quality Incentive Program for 2020 so that CCOs earn credit for reporting only.
For a detailed report of the CCO metrics and how much each CCO earned through the pay-for-performance program, visit the OHA Health Policy and Analytics website.
# # #