1. 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

2. 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

3. 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]

4. 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

5. 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

6. 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

7. 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

8. 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