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CCO Metrics Overall Population

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Welcome

Measuring quality and access to care, and holding CCOs accountable to key metrics, is a cornerstone of Oregon’s health system transformation. We report quality measures to help us see if CCOs are improving the quality of care for Oregon Health Plan (Medicaid) members.

The CCO Quality Incentive Program rewards exceptional care and continuous quality improvement by CCOs. Specifically, CCOs receive annual bonuses based on their performance on a set of incentive measures. To learn more about the CCO Quality Incentive Program, please visit our resources webpage.

Frequently Asked Questions      Definitions      Download Data

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CCO Metrics: Overall Population

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Frequently Asked Questions

CCO metrics come​​​ from multiple data sources. Most metrics come from administrative (billing) claims data. ​We list each metric's data source below the charts.​

Administrative (billing) claims: Claims are primarily used for health care payments but can also be used for utilization and other quality measures. A few administrative metrics use a hybrid of data sources, such as claims with immunization registry or claims with electronic health records (EHR).

Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey: CAHPS is an annual survey asking patients about their experiences with health care. The survey focuses on aspects of health care quality that patients can best assess, such as the communication skills of providers and ease of access to services.

Electronic health records (EHR): EHRs are records kept by clinics during a health care visit. Only a handful of CCO metrics come directly from EHRs.

​Most CCO metrics use full population data. This means that we know the service rate for all eligible members. However, for some measures only a small number of members may be served in a year.

For metrics with small eligible populations, changes year-over-year can fluctuate dramatically. These fluctuations may be based on a handful of members or changes to the population, rather than a change in health care services. As such, year-over-year comparisons need to be interpreted with caution.

We add this warning to CCOs with:

  • ​Administrative (billing) claims and EHR​
    • ​Metrics with percent rates
      • Fewer than 30 eligible members (denominator) or
      • Fewer than 12 members served (numerator)​.
    • All-Cause Readmission metrics
      • ​Fewer than 150 inpatient eligible visits (denominator) or
      • Fewer than 60 inpatient visits occurred (numerator).
    • ​Ambulatory metrics
      • ​​Fewer than 360 eligible member months (MM) (denominator) or
      • Fewer than 60 emergency department visits occurred (numerator).
  • CAHPS survey
    • Fewer than 30 members responded to the question (denominator); 
    • Fewer than 3 members agreed (numerator); 
    • All or no members agreed (rate 100% or 0%); or

    • The relative standard error (RSE) w​as greater than or equal to 30%.

In this dashboard, we follow guidelines on small number reporting from OHA's Office of Health Policy and Analytics (HPA)​ with one exception. We do not suppress any CCO service rates for the overall population. Because some metrics have small eligible groups (for example, Assessments for Children in ODHS Custody), we do not​ report the denomintor (number of eligible members) for CCOs. We do this to protect member confidentiality.

​​In chart titles, we describe the change over time. Descriptions are based on percent change, or the relative rate of change. For example, a 100% increase means the rate doubled from one year to the next. 

For consistency, we use the following descriptions for ranges in percent change:
  • ​Improved: 10% or more
  • ​​Slightly improved: 3.01% to 9.99%
  • Held steady: -3% to 3%
  • Slightly worsened: -3.01% to -9.99%
  • Worsened: -10% or less​​

​To encourage ongoing improvement, CCOs can meet a measure by achieving either 1) the benchmark or 2) a CCO-specific improvement target.

  • Benchmarks are the same for all CCOs. This benchmark is meant to be an aspirational goal, generally at the 75th or 90th percentile of national performance. 
  • Improvement targets are smaller goals specific to each CCO, between their prior year's rate (baseline) and the benchmark. Specifically, CCO-specific improvement targets are a 10 percent reduction in the gap between their baseline and the benchmark.

Benchmarks and minimum improvement targets are set annually by a public body called the Metrics and Scoring Committee​. The public is welcome to attend Metrics and Scoring Committee meetings and provide public testimony​.​

​We use the Minnesota Department of Health Quality Incentive Payment System method to calculate improvement targets, called the Minnesota method. With this method, CCOs must reduce the gap between their prior year's rate (baseline) and the benchmark by 10 percent (or one-tenth). 

For example, if the benchmark is 50% and a CCO’s baseline is 20%, then the CCO would need to improve by 3 percentage points (ppt).

Minnesota method: (50% - 20%) / 10 = 3% 

Improvement target: 20% + 3% = 23% 

With the Minnesota method, CCOs would never have to reach the benchmark. They would only have to get closer to the benchmark each year. This is why the Metrics and Scoring Committee selects a "floor" or minimum goal. 

I​f the Minnesota method is lower than the floor, then the floor will be added to the baseline. For example, if the Minnesota method was 1 ppt and the floor was 3 ppt, the CCO would need to improve by 3 ppt.​​

​In 2020, the COVID-19 pandemic upended the CCO Quality Incentive Program's usual processes. Under the original 2020 CCO contract, OHA was to withhold 4.25% of each CCO’s per-member per-month (PMPM)​ or capitation payments to fund the Quality Pool. Due to the pandemic, the withhold was suspended in April 2020 so funds could be infused into the health care system. This resulted in about $17 million or more per month to help CCOs address critical needs.

The funds withheld from January to March (Quarter 1) 2020 remained in the Quality Pool. In July 2020, the Metrics and Scoring Committee suspended all 2020 benchmarks. This meant that CCOs only had to report data on incentive metrics to earn bonuses.​ All CCOs met this report-only requirement.

There are instances when OHA will recalculate a CCO's baseline, or their prior year's rate. We do this when there is a change to the metric (for example, what ​is counted or who is eligible). Recalculating the baseline can lower or raise the following year's improvement target. By doing so, we ensure that baselines and improvement targets are comparable.

For consistency, however, we generally do not report recalculated baselines. For reporting, we prioritize the rate first published, which aligns with incentive payments. If we do report a recalculated rate, we flag this under Notes.​

Because of this, a CCO's baseline may look worse than their improvement target in the following year. If you have questions, please contact us at Metrics.Questions@odhsoha.oregon.gov.​

​OHA works with CCOs throughout the measurement year to look for patterns in performance and to use quality performance data. During the measurement year, OHA provides every CCO a quarterly dashboard for claims-based incentive metrics with information that can be parsed at the member level to better understand service use. Because this dashboard is updated regularly, CCOs and OHA are able to work together throughout the year to validate measure results. Any discrepancies in reporting can be quickly identified and corrected with smaller lag times. In addition, CCOs can use the ongoing data to target quality improvement efforts.

The CCO Metrics Technical Advisory Group (TAG) typically meets on a bimonthly cycle to identify, discuss and resolve metric questions and challenges at the operational level. The Metrics TAG meetings are coordinated with OHA's Transformation Center, which provides practical support directly to CCOs and clinics. In addition, OHA supports Innovator Agents​ to serve as liaisons between CCOs and OHA. The Transformation Center and Innovator Agents help remove communication barriers and ensure OHA remains in touch with each CCO’s community.

At the conclusion of every measurement year, OHA offers a three-week validation period. During this phase of the program, CCOs can ask for clarification about the rules or calculations for any metric and provide additional documentation for the measures as appropriate.

For more information, please visit CCO Quality Incentive Program Res​ources.


Definitions

A coordinated care organization (CCO) is a local health plan that offers Oregon Health Plan (Medicaid) benefits through a network of physical, behavioral and oral health care providers.​ Each CCO agrees to work together with their local communities to serve people who receive health care coverage under the Oregon Health Plan. CCOs were formed in Oregon in late 2012.

CCOs have the flexibility to support new models of care that are patient-centered and team-focused and eliminate health inequities. CCOs are able to better coordinate services and focus on prevention, chronic illness management and person-centered care. They have flexibility within their budgets to provide services beyond medical benefits. 

Requirements for CCOs have evolved over time and a new phase, CCO 2.0, began in 2020. CCO 2.0 priority areas include work to improve the behavioral health system; increase value and pay for performance; focus on social determinants of health and health equity; and maintain sustainable cost growth.

​A set of health care quality metrics that CCOs must improve on to earn bonus funds. Incentive metrics are selected by a public body called the Metrics and Scoring Committee. The committee also selects how much CCOs must improve by with benchmarks and improvement targets (see Frequently Asked Questions​ above for more information). The public is welcome to attend Metrics and Scoring Committee meetings and provide public testimony​.​​

​The Health Aspects of Kindergarten Readiness strategy aims for health system behavior change, investments and cross-sector efforts to improve kindergarten readiness. This multi-measure strategy was developed by the Health Aspects of Kindergarten Readiness Workgroup and was endorsed by the Metrics and Scoring Committee​. 

In 2024, there were three quantitative CCO metrics in the broader Kindergarten Readiness strategy: Child and Adolescent Well-Care Visits (Ages 3-6); Preventive Dental or Oral Health Services (Ages 1-5); and Young Children Receiving​ Social-Emotional Issue-Focused Intervention/Treatment Services.

​Upstream measures focus on the social determinants of health. Upstream measures are typically unique to Oregon and are created by OHA and community partners. Social determinants of health (often abbreviated to SDOH) means: 

  • Nonmedical factors that influence health outcomes, 
  • The conditions in which individuals are born, grow, work, live and age, and 
  • The forces and systems that shape the conditions of daily life, such as economic systems, development agendas, social norms and policies, racism, climate change and political systems.

General Information

​Data file released November 25, 2025:
CCO Metrics_Overall Population_Release 2025.1.xlsx​

Release 2025.1 (published November 25, 2025)

​Data corrections:

  • ​​​Corrected 2020 original benchmarks for Preventive Dental or Oral Health Services (Ages 1-5) and (Ages 6-14).
Starting in measurement year 2024, we added the following measures to our reporting. These measures come from the Centers for Medicare & Medicaid Services (CMS) Core Sets:
  • Ambulatory Care Sensitive Emergency Department Visits for Non-Traumatic Dental Conditions in Adults (EDV-AD)
  • Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB)
  • CAHPS: Rating of Health Plan - Adults (CPA-AD)
  • CAHPS: Rating of Health Plan - Children (CPA-CH)
  • Concurrent Use of Opioids and Benzodiazepines (COB-AD)
  • Oral Evaluation During Pregnancy (OEVP)
Measurement year 2024 was the first year of quantitative data reporting for the following Upstream metric:
  • ​​Young Children Receiving Social-Emotional Issue-Focused Intervention/Treatment Services

Starting in measurement year 2024, we no longer report the following measures. With Senate Bill 966, these measures are no longer eligible for the CCO Quality Incentive Program:

  • Ambulatory Care: Emergency Department Utilization
  • Any Dental Service
The Patient-Centered Primary Care Home (PCPCH) Enrollment metric has been moved to PDF reports, which will be posted on our Dashboards and Reports webpage once available.

Starting in measurement year 2024, we updated metric names and abbreviations to align with the CMS Core Sets and measure stewards. For most metrics, this was a minor update. The following metrics had more substantial name changes:​

Previous nameUpdated name
CAHPS: Access to CareCAHPS: Getting Care Quickly (CPA)
CAHPS: Access to Dental CareCAHPS: Regular Dentist (CPA)
CAHPS: Overall Rating of Health CareCAHPS: Rating of All Health Care (CPA)
CAHPS: Satisfaction with CareCAHPS: Customer Service (CPA)
Health Equity: Meaningful Language AccessMeaningful Language Access (Health Equity)
Oral Evaluation for Adults with DiabetesAdults with Diabetes - Oral Evaluation

Additionally, we have updated filters to align with metric names and abbreviations. Please note the following when searching for metrics:

Previous filter nameUpdated filter name
ADHD Medication (Initiation)Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication: Initiation Phase (ADD-CH)
ADHD Medication (Continuation)Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication: Continuation and Maintenance Phase (ADD-CH)
Adolescent Immunization: Combo 2Immunizations for Adolescents: Combo 2 (IMA-CH)
Dental Sealant at Least One First Molar
Sealant Receipt on Permanent First Molars: Rate 1 - At Least One Sealant (SFM-CH)
Dental Sealant All First Molars​
Sealant Receipt on Permanent First Molars: Rate 2 - All Four Molars Sealed (SFM-CH)
Depression Screening and Follow-Up (EHR)Screening for Depression and Follow-Up Plan (CDF-AD)
Pharmacotherapy for Opioid Use DisorderUse of Pharmacotherapy for Opioid Use Disorder (OUD-AD)
Psychosocial Care for Children on AntipsychoticsUse of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP-CH)
Substance Use Treatment: EngageInitiation and Engagement of Substance Use Disorder Treatment: Engagement (IET)
Substance Use Treatment: InitiateInitiation and Engagement of Substance Use Disorder Treatment: Initiation (IET)

​​CCO Metrics Program (2025). CCO Metrics: Overall Population​. Dashboard accessed [MM/DD/YYYY]. Portland, OR: Oregon Health Authority. https://www.oregon.gov/oha/HPA/ANALYTICS/Pages/CCO-Metrics-Overall-Population.aspx​​



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