OHA announces applicants for 2020-2024 coordinated care contracts

The Oregon Health Authority (OHA) has received nineteen applications from organizations seeking contracts to serve as coordinated care organizations (CCOs) for the Oregon Health Plan’s nearly 1 million members. The contracts start January 1, 2020, and go through December 31, 2024. Awards for the CCO contracts are expected to be announced in July 2019.

"OHA’s goal is to transform health care for every Oregonian by reducing costs, improving access to mental health services, rewarding providers for improving health outcomes, and addressing issues outside the doctor’s office that impact health," said OHA Director Patrick Allen. "OHA will be evaluating the applicants based on their ability to deliver on these goals." Oregon first established CCOs in 2012 to transform health care delivery in the state. CCOs bring together physical, behavioral, and oral health providers to coordinate care for people on the Oregon Health Plan. They improve health and reduce costs by providing more coordinated, flexible and innovative services. CCOs are rewarded for achieving specific health outcomes and quality measures. Nearly 87 percent of Oregon’s 1 million OHP members are enrolled in CCOs.

In October the Oregon Health Policy Board approved a comprehensive set of policies to improve the health of Oregon Health Plan members, address health disparities, control program costs, and continue to transform health care delivery in our state. This next phase of health care transformation is known as "CCO 2.0."

The four priority areas for improvement identified by Governor Kate Brown and advanced by the Oregon Health Policy Board’s policy recommendations are

• Improve the behavioral health system and address barriers to access to and integration of care.
• Increase value and pay for performance.
• Focus on social determinants of health and health equity.
• Maintain sustainable cost growth and ensure financial transparency.

OHA’s request for applications (RFA) criteria asks applicants to demonstrate their capacity to achieve the objectives of CCO 2.0. Applications will be evaluated in the following areas:

• Care coordination and integration: Ability to coordinate with outside entities (including public and community-based organizations), between levels of care, for special populations of members and to integrate behavioral and oral health services.
• Delivery system transformation: Innovating to improve care delivery and quality (including primary care), access to culturally and linguistically appropriate care, measurement of value and efficiency of services.
• Community engagement: Strength of the Community Engagement Plan and of community engagement in developing the application.
• Clinical and service delivery: Utilization monitoring, ensuring appropriate access to services, clinical review and prior authorization, and approach to addressing complaints and grievances.
• Business administration: CCO business processes, member engagement and outreach, adoption of electronic health records, data systems, and supporting members during transition.
• Finance: Applicant solvency, ownership and affiliations, National Association of Insurance Commissioners (NAIC) reporting, arrangements with pharmacy benefit managers, plans for increasing value-based payments, tracking and reporting of social determinants of health investments and outcomes, managing within the global budget, and cost containment.

Applications will be reviewed by teams with expertise in the areas under review.

Based on the applications, Oregon Health Plan members in every county in Oregon would have at least one CCO to coordinate their health care. In many parts of the state, multiple organizations submitted applications to operate in the same counties, giving Oregon Health Plan members more than one CCO choice.

Applications received by OHA and proposed service areas

Additional information about the CCO 2.0 RFA process can be found on the CCO 2.0 page on the OHA website.