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OHA signs contracts with 15 coordinated care organizations

Sets deadlines for CCOs to ensure they are ready to begin services January 1, 2020

The Oregon Health Authority (OHA) announced it signed contracts with 15 organizations to serve as coordinated care organizations (CCOs) for the Oregon Health Plan’s nearly 1 million members. The contracts set new requirements for CCOs to improve care for OHP members and hold down cost increases in Oregon’s Medicaid program. The contracts represent the largest procurement in state history, totaling more than $6 billion for the 2020 contract year.

Eleven of the organizations received five-year contracts, and four organizations received one-year contracts. The new CCO contract services start January 1, 2020. Total costs for the 2020 contract year are within the state’s 3.4 percent growth target.

"These contracts build on the original vision for CCOs," said Oregon Health Authority director Patrick Allen. "At the same time, they hold CCOs and the Oregon Health Authority more accountable for working together to deliver better results for OHP members and taxpayers. Over the next five years, these contracts will give us more tools to help Oregonians be healthier at home, in school and in their communities, improve access to mental health and substance use services, reduce health disparities, and get better health and quality outcomes for dollars we spend on health care."

All CCOs are required to show they have a network that is adequate to serve their members. Eight of the contracts include conditions that must be met to address provider network adequacy and pending provider contracts. These eight CCOs have service areas where members will have CCO choices this fall.

The conditions require the CCOs to ensure OHA has appropriate, up-to-date information on their contracted providers to determine how many members they can serve in 2020. They must also demonstrate they can meet state and federal requirements that apply to all CCOs for access to in-network hospitals, primary care providers, specialists, and pediatric oral health providers. CCOs have until December 1 to meet the conditions.

Readiness review

OHA is also announcing the initial results of the first round of the federally mandated readiness review. CCOs were evaluated for their readiness to provide services starting January 1. All 15 CCOs met most or nearly all of the requirements.

The first round of evaluation included eight "critical" categories that directly impact a member’s ability to access health care services. In each category, CCOs were rated in 93 elements as: complete, progress sufficient to start operations, or incomplete. OHA is asking all CCOs to take actions to improve items rated as incomplete or progress sufficient to start operations. CCOs will be required to provide documentation showing the issues have been resolved by December 1.

OHA is finalizing remediation plans for the four CCOs that received one-year contracts (AllCare, Cascade Health Alliance, Umpqua, and Yamhill County Care Organization). During readiness review, many deficiencies in the applications were improved and requirements to correct those have been removed. OHA is working closely with the four CCOs to ensure they have the necessary plans, procedures and practices to meet the goals of CCO 2.0.

2020 capitation rates

OHA has also finalized the 2020 capitation rates for CCOs. These rates are the per-member-per-month amounts the state pays CCOs to coordinate health care for OHP members. The average net payment in 2020 is $471. The 2020 rates include multiple budget-neutral adjustments such as the inclusion of the quality pool program within the rates and a change in how hospitals are reimbursed. These changes impact a comparison between 2019 and 2020 rates. The rate increase meets the 3.4 percent rate-of-growth target for state general funds.

Due to the passage of HB 2267 in the Legislature’s 2019 session, 2020 rates will be recalculated in summer 2020 and be applied retroactively to January 2020. The recalculation is intended to account for any changes to CCO member enrollment during the transition from 2019 to 2020 contracts.

Additional resources:

The Contract Awardees page on the CCO 2.0 website has additional information about the contracts, readiness review and rates including:

  • Signed 2020 contracts.
  • Conditional letters.
  • Readiness review reports.
  • 2020 capitation rates.

CCO 2.0 Contract Awardees

Awardee Service Area Received Conditions Letter Projected members* Percent Readiness Review Elements Complete
AllCare CCO Inc. Curry, Jackson, Josephine, and partial Douglas 60,688 83%
Cascade Health Alliance Partial Klamath County   18,787 80%
Columbia Pacific CCO, LLC Clatsop, Columbia, and Tillamook   25,653 77%
Eastern Oregon Coordinated Care Organization LLC Sherman, Gilliam, Morrow, Umatilla, Union, Wallowa, Wheeler, Grant, Baker, Lake, Harney, and Malheur
  51,235 84%
Health Share of Oregon Clackamas, Multnomah, and Washington 276,583 62%
InterCommunity Health Network dba InterCommunity Health Network Coordinated Care Organization Lincoln, Benton, and Linn   56,663 75%
Jackson County CCO, LLC, dba Jackson Care Connect Jackson County 31,331 77%
PacificSource Community Solutions - Central Oregon Crook, Deschutes, Jefferson, and partial Klamath Counties   48,370 81%
PacificSource Community Solutions - Columbia Gorge Hood River and Wasco   12,034 81%
PacificSource Community Solutions - Lane Lane County 28,778 81%
PacificSource Community Solutions - Marion Polk Marion and Polk 100,434 81%
Trillium Community Health Plan Inc. (Trillium) Lane, Clackamas, Multnomah, and Washington; partial Linn and Douglas 106,135 96%
Umpqua Health Alliance, LLC Douglas 27,629 94%
Western Oregon Advanced Health, LLC abn Advanced Health Coos and Curry   20,380 89%
Yamhill County Care Organization Yamhill, partial Polk and Washington 27,648 76%

*The projected numbers are based on the data used to populate the October 16 letters to OHP members. These numbers are subject to change, especially in areas where members are making choices about CCOs in October and November.

 Media contact

Allyson Hagen

OHA External Relations


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