About Non-profit, public benefit corporation that manages Medicare and Medicaid services More than 200,00 OHP and 13,000 Medicare Advantage members ~25% of the total Medicaid population in Oregon Most CareOregon Advantage (Medicare) members are enrolled in our Special Needs Plan for dually-eligible members 76% of members live in the Portland metro area 54% of members are female 26% do not speak English as their first language 46% self identify as non-Caucasian

Legislative History Leading to Oregon’s Healthcare Transformation 2009 Oregon Legislature HB 2009 “Healthy Oregon Act” 2010 U.S. Congress Patient Protection & Accountable Care Act (PPACA or ACA), aka “Obamacare” 2011 Oregon Legislature HB 3650 – Health Care Transformation Created concept of a CCO Charged the Oregon Health Policy Board with coming up with a plan for CCO implementation 2012 Oregon Legislature SB 1580 – Coordinated Care Organizations Essentially endorsed OHPB’s plan for CCO implementation

Vision of HB 3650 and CCO Implementation (2011 Legislative Session, Oregon Legislature) Integra tion & coordi nation of benefits & services Local accoun tability for health & resource allocatio n Standa rds for safe & effective care Global budget indexed to sustaina ble growth Redesigned Delivery System Healthi er popula tion Improv ed Outco mes Reduce d Costs [The Triple Aim] [A CCO]

What is a Coordinated Care Organization (CCO)? What is a CCO? What is a Coordinated Care Organization (CCO)? A CCO is a single organization that accepts responsibility for the cost of health care within a global budget and for delivery, management and quality of care delivered to the specific population of patients enrolled with the organization. MCO, DCO, MHO, Rx, County Programs, Medicare, Medicaid, Specialty, Hospital, PCPCH Fragmented, Siloed System CCO Shared Systems & Learning Coordination & Communication Local Accountability Global Budget Coordinated “Commons” System

Key Principles for Governing the Commons: Commons as metaphor for Coordinated Care Individuals know the boundaries and limits Of the resource (“Common Pool Resource”) Of the community of users (“Appropriators”) Rules are locally made and adapted to context Decisions are made together Active measurement and monitoring Effective sanctions Mechanisms for conflict resolution Latitude from higher authorities to act locally Nested Commons Source: Elinor Ostrom quote by Don Berwick in 2009 IHI Forum Plenary

CCO Theory Demands a more horizontal approach Democratizing systems that promote health, not just health care Dependent on a network model Interdependent / Inter-independent agents CCO Shared Systems & Learning Coordination & Communication Local Accountability Global Budget Requires involvement and input of a multitude of stakeholders Is accountable to those stakeholders Is a community solution, as opposed to an industry solution No longer every man (organization) for itself

Key Components of CCO Development Geographic/Demographic Scope Business & Operations Information Systems Utilization Management Administration Claims Processing Customer Relations Workforce Development Local Governance Board of Directors Community Advisory Council Model of Care Physical, mental, oral health integration Social service networking/integration Delivery system transformation Keeping people healthy Financing Global Budget Capitalization Risk Revenue Alternative Payment Methodologies

Why would Oregon’s health systems agree to do all this just for Medicaid? Post-ACA, 25% of Oregonians are enrolled in Medicaid $1.9 Billion in federal investment  accounts for 19% of the state’s Medicaid budget in the ‘13-’15 biennium Unclear what the expiration of this investment will do The CCO Metrics dollars are real money Policymakers are pushing to fold all publicly-funded health coverage into the CCO model PEBB & OEBB If that happened, ~40% of Oregonians would have care paid for and coordinated by CCOs