During the COVID-19 public health emergency, COHO CCOs have continued to invest in their communities to improve access to health care services. One such investment serving thousands of Oregon Health Plan (OHP) members is the Trillium Resource Exchange, or T-REX for short.

This investment, made by Trillium Community Health Plan helps connect OHP members to nearby resources they need, like local food banks, housing and utility resources, and more. It’s translated into over 100 languages to help ensure language is not a barrier to accessing care.

This investment is not only available for OHP members. Traditional health care workers, providers, and others who work regularly with OHP members can access this database in order to provide extra support.

T-REX is a user-friendly program that allows health care providers, care teams, and non-profit services providers to send and receive referrals and update the status of referrals easily and efficiently. T-REX also connects to electronic health records so providers are able to seamlessly manage their patients’ care.

Why are investments like these important to Oregon’s health care system?

Investments like these address Social Determinants of Health and Equity (SDoH-E). Other examples of SDoH-E investments include funding food banks, shelters, interpreters, and more. These evidence-based investments help decrease health inequities and keep OHP members healthier.

Our CCOs have shown evidence-based SDoH-E play a significant role in a person’s health, in turn reducing the cost of health care for Oregon. We know that when individuals have food and housing security, they are more likely to be healthy. This focus on preventive services results in fewer ER visits and other more expensive health services – saving the state money. For these reasons, CCOs spend millions of dollars each year investing in specific supports that their individual communities need. Programs like T-REX make sure this network of resources is readily available to our most vulnerable communities.

Nurturing Investment

If our goal is to ensure Oregonians remain healthy, we need to create stable funding streams for initiatives that fit each of their communities’ unique needs. We are doing a disservice to Oregonians working to rise out of generational poverty, trauma, and poor health if the programs they rely on only exist in sporadic timelines.

We are working to identify sustained funding streams for programs with proven long-term health outcomes. Investing in overall health is long game, and our CCOs are intent on keeping these programs in place.

About COHO

COHO is a coalition of six locally-based coordinated care organizations charged by the legislature to deliver care to Oregon Health Plan (OHP) members. COHO CCOs serve just over 184,000 OHP members or approximately 16% of the statewide membership.

In the face of a pandemic, the Coalition for a Healthy Oregon’s coordinated care organizations (CCOs) have been stepping up to ensure their members receive the care they need promptly and effectively

Earlier this month, the Roseburg News-Review ran a story about a toddler, Jameson Wilson, who has a chronic condition called eosinophilic esophagitis. This condition causes an allergic reaction in the esophagus and was preventing Jameson from being able to eat, as well as causing him to break out in eczema rashes. The boy’s parents tried to switch his formula and consult his doctors, but his symptoms persisted, and he was unable to keep food down.

Finally, Jameson’s mother decided to switch his care to Tasha Rutledge, a nurse practitioner at Umpqua Health-Newton Creek, a health clinic operated by COHO member Umpqua Health Alliance and offers expert pediatric and adult primary care in Douglas County. Care for Jameson was immediately approved, and Jameson was put on a treatment plan that centered around eliminating foods and most formulas.

This was a large financial burden for Jameson’s parents, until the Women, Infants, and Children (WIC) program helped to cover the costs. However, since Jameson would potentially have this condition for the rest of his life, long-term solutions were necessary. Rutledge also approved for Jameson to have a gastronomy tube surgically inserted into his abdomen to deliver nutrition directly into his stomach.

Because CCOs are able to tailor delivery of care to the specific needs of their community, they are able to act quickly and provide the right care at the right time. Oregon has one of the most advanced Medicaid delivery systems in the nation, and this success story is one of the many examples that show the high-quality and effective care that COHO CCOs deliver across our state.

To read all about Jameson’s journey of receiving his gastronomy tube during COVID-19, you can read the full article here.

Partnership Builds Momentum for COHO’s Aggressive Legislative Agenda

MCMINNVILLE, Oregon – The Coalition for a Healthy Oregon (COHO) is pleased to announce that Yamhill Community Care has joined its statewide association of coordinated care organizations that now represent more than 184,000 members of the Oregon Health Plan.

The six members of COHO provide high-quality health care and wellness services to people who qualify for Medicaid due to low income or disability.

“Yamhill CCO shares COHO’s values, which include a commitment to local, patient-centered care and innovation to improve population health,” said Doug Flow, COHO President. “The resources and perspectives brought by the hardworking professionals of Yamhill CCO will better position COHO for success in its 2021 legislative agenda and beyond.”

While presenting myriad challenges to the health care system, the coronavirus pandemic showed the strengths of Oregon’s local coordinated care model. With boots on the ground and strong relationships in every community, CCOs throughout Oregon were well positioned to provide immediate assistance to Medicaid recipients, participating providers, and county public health departments. However, the crisis has led to a steep decline in state revenues, which could jeopardize the viability of the system, particularly in rural areas. CCOs have been a critical lifeline for them private health care providers Oregonians rely on.

“COHO is Oregon’s most effective organization for CCO policy development and health systems innovation,” said Dr. Seamus McCarthy, CEO of Yamhill CCO. “We look forward to engaging strongly in the legislative process as a member of COHO and will benefit from its expert communications and top-tier governmental advocacy.”

COHO members provide health services that center and prioritize the patient-provider relationship. They have been top performers statewide in quality health metrics and keeping people out of high-cost care, such as emergency departments. The effect has been to save taxpayer dollars while improving population health, in line with Oregon’s Triple Aim for better health, better care, and lower costs.

Long before the recent focus on health equity, COHO has been a leader in addressing health disparities in underrepresented communities. By investing in the Social Determinants of Health and Health Equity, COHO has worked to break down barriers to health through strategic investments and innovative policy development. This means addressing health factors like food, housing, education, and transportation to produce greater health outcomes for the most vulnerable members of our society.

Last week, the Oregon Health Authority and the Oregon Health Leadership Council released a study which seeks to identify ways to lower the cost of health care by eliminating “low-value” services – medical treatments, tests, and procedures that have been shown to provide little benefit in certain clinical scenarios.

In the battle to rein in ever-increasing costs of hospital services and pharmaceutical drugs, this study may be a small piece of the conversation in decreasing health care cost. It is by no means a silver bullet.

The study, Better Health for Oregonians: Opportunities to Reduce Low-Value Care, utilizes the Milliman Waste Calculator, a software tool that looks at 48 measures, treatments, and procedures to identify and quantify low-value health care services. The Oregon survey included commercial insurance, Medicare, and Medicaid. Of all three groups, Medicaid had the lowest occurrence of “low-value” services and spent the least on this type of care.
Background

Though our state leads most others in innovative and efficient Medicaid coverage, the conversation continues on how to reduce the cost while increasing the effectiveness of health care. Many pieces of legislation that have been introduced over the years, including capping pharmaceutical costs of specific drugs, importing less expensive drugs from other countries, and partnering with other states to increase our pharmaceutical purchasing power. None of these became law.

So in the 2019 regular session, the Oregon Legislature passed SB 889, which created a Health Care Cost Growth Benchmark program that controls the growth of health care expenditures in the state. This program is still in review by a governor-appointed committee to cap the cost growth of health care for commercial insurance and address other causes for the steady rise of health care costs.

We know that 50% of projected spending growth in our public health system is from increasing prices, meaning that the amount of money we spend on low-value care pales in comparison to what we could save if we had other cost-control checks in place.
Policy Concerns

There are also many factors that play into why decreasing the use of low-value care is complex and problematic. In November 2019, OHA Director Pat Allen gave a presentation about what the focus of the SB 889 cost-growth benchmark committee would be. An example of unnecessary services included a patient requesting an X-ray for a sprained ankle, even though their ankle was not broken. The assertion received bipartisan pushback as both Rep. Teresa Alonso Leon and Rep. Christine Drazan said women and people of color can be discriminated against in health care settings, which lead to negative health outcomes for those groups. Furthermore, if an OHP member does have a sprained ankle but wants an X-ray to be sure it is not broken, would it be medically ethical to refuse this service?
Preventive Care Decreases Cost

The Coalition for a Healthy Oregon (COHO) is dedicated to breaking down barriers like these by investing in the social determinants of health, like ensuring that Oregonians who do not speak English have access to certified interpreters, or hiring a graduation coach to ensure that children of color are graduating at the same rate as their white counterparts.

We’ve always known that preventative care, like an X-ray to ensure an ankle is not broken, a cancer screening, or educational attainment, saves us all money in the long run. With Medicaid having the fewest “low-value” services in this study, we hope the Health Care Cost Growth Benchmark committee utilizes this study as a small piece of the conversation instead of a catch-all response to solve the state’s rising health care costs.

In Oregon, about 23.8 percent of our population uses the Oregon Health Plan (OHP) for their health insurance. That means CCOs across the state are serving roughly 984,106 Oregonians by ensuring they have access to equitable, timely, and appropriate health services. This current organization that utilizes CCOs as a single point of contact for Medicaid health services is not always what OHP looked like.

In 2012, our state was at a breaking point. If we did not change the way we ran our Medicaid delivery service, we were looking at taking a 33 percent cut in reimbursement rates to providers. Because the Medicaid reimbursement rate is already much lower than other health insurance companies offer, this cut would have decimated the Oregon Health Plan. Health care providers across the state would have been unable to see Oregonians on OHP because the rate would not have covered the cost of the visit to the provider.

Not only were we looking down the barrel of a giant cut in reimbursement rates, the system that we had was not working for OHP members, either. Instead of OHP being a single over-arching health plan that included physical health, mental health, and dental health, it was broken into three different plans. These plans did not communicate among themselves, making it incredibly difficult for OHP members to understand how their Medicaid coverage worked, and how to effectively navigate the system.

Former Governor Kitzhaber, as well as several legislators, lobbyists, and other elected officials, stepped in to address not only the budgetary issue, but the concern that Oregonians were not receiving the care they needed due to systemic problems. To address the concern that Oregonians could not navigate the current Medicaid system, Governor Kitzhaber recommended the state create a single point of contact for physical, mental health, and dental services that works to organize not only OHP members, but providers as well. He thought that by coordinating the care that OHP members were receiving, we could increase our efficiency and decrease the cost.

Dr. Bruce Goldberg, the Director of the Oregon Health Authority at the time, was also at the forefront of the state’s push to re-organize our Medicaid system. Dr. Goldberg believed that we could make OHP easier to navigate, save the state dollars on health care, and push for incentives that create better health outcomes for Oregonians.

So, Governor Kitzhaber, Dr. Bruce Goldberg, Rep. Tina Kotek, Rep. Tim Freeman, and Sen. Alan Bates worked with lobbyists including Paul Phillips and Josh Balloch to create a new Medicaid program that would serve Oregonians, save our Medicaid program, push for better outcomes, and save the state money. Their ideas were groundbreaking and included concepts like utilizing a global budget for CCOs, creating incentive programs to increase positive health outcomes for Oregonians, and setting rate of growth allowances to lower than the national average.

Every piece of this legislation was important. Global budgets ensure that the CCO, instead of the state, takes on the risk of paying out reimbursements for members. Incentives for CCOs to increase positive health outcomes push CCOs to continue transforming health care in new and creative ways, like including social determinants of health spending on food security, housing security, etc. Finally, setting the CCO’s rate of growth allowance 2% below the national average could save $2 billion dollars over four years.

Not everyone was a fan of the new plan for Medicaid. Powerful status quo providers were not interested in changing the way OHP was structured, and there were several other competing pieces of legislation. On top of that, the House was evenly split between 30 Republicans and 30 Democrats and headed by two co-speakers, making the job of these public officials and lobbyists even harder. Fortunately, this legislation passed off the Senate floor with 18 votes, and off the House floor with 53 votes. This was only possible because of the hard work of the many advocating for this change, and the bi-partisan understanding that Oregonians need access to quality health care.

The final step was securing federal funds to jump start the program. Gov. Kitzhaber and Director Goldberg flew to the White House to meet with President Obama. They shared our state’s revolutionary ideas for Medicaid delivery, and requested $1.9 billion dollars in Federal funds to start the program. They shared with the President that they planned to cap the CCOs at 2% below the national average rate of growth in health care so that they could save the Federal government $2 billion dollars within four years, effectively paying back the state-up money. President Obama approved the funding request whole-heartedly, and the Oregon Health Plan was reborn.

The legislation that they dreamt up in 2012 is still in effect today, ensuring that Oregonians get the care they need, the state saves money, and that we continue to push for health transformation that stays true to the original member-centered, locally-controlled CCO model.
Thank you, Governor Kitzhaber, Dr. Goldberg, Rep. Kotek, Commissioner Freeman, the late Sen. Bates, COHO lobbyists and members who helped conceive and pass this legislation, and the countless others who were involved in fighting for the Medicaid delivery system we have today!

We have known for quite some time that our schools play a stabilizing role in many families’ lives, providing access to resources along with an education. Many schools were helping to ensure children were eating on a regular basis at reduced or waived rates, connecting children and parents to social services and community supports, and providing some mental health supports. During COVID-19, the question is: how do we now get these supports to children during a global crisis?

On top of that, children being out of school during the COVID-19 pandemic to halt infection rates has caused parents across the state headaches. As well, for parents who do not have the ability to work remotely, this pandemic has created much different obstacles including lack of income, which may lead to food and housing insecurity.

AllCare Health has long been dedicated to ensuring that children have access to resources that they need so they can succeed in school. For example, AllCare noticed that the children of color in a specific school were graduating at far lower rates then their white counterparts. To rectify this, AllCare invested in a Graduation Coach for the school, who was able to increase graduation rates in children of color from about 21% to 96% in the span of five years.

Now, during COVID-19, AllCare is not only ensuring that children are getting fed despite their lack of access to school meals, but they also just invested $10,000 in the Chetco Community Public Library to provide Grab & Go Summer Activity Kits for children across their service area! In June, 950 Summer Activity Kits were handed out, which contained activities that encourage children to stay engaged in learning during the summer. These activities included: sidewalk chalk, crayons, pencils, notebooks, birdhouse kits, paints, flower seeds with soil disks, flowerpots, literacy games, new high-interest hardcover books in English and Spanish, and inserts in the bag from local health and social services in English and Spanish, letting kids and families know where they can turn in emotional or financial distress. These bags are even color-coded to show the differences between preschool, school-age, and teen youth activity kits.

AllCare understands that many parents who have been laid off are trying to navigate life without an access to income, all while caring for their children and trying to facilitate distance learning. By providing these kits, AllCare is providing children with fun, engaging activities for the summer, information on much-needed resources and how to access them, and a sense of support and community. AllCare Health also knows how important education is and hopes that this program can continue to support at-risk children in their journey to becoming an independent learner.

These Grab & Go Activity Kits were so popular with families in their service area, AllCare expanded the program to give out 500 Activity Kits each Wednesday in July. At this rate, by the end of the month, more than 2,500 children will have access to activities that keep them engaged and learning while parents are hard at work. And, every single one of those families will have information on the community supports they may need if they are in emotional or financial duress.

Wondering how AllCare Health can fund initiative like this, even though their technical job is ensuring Oregon Health Plan (OHP) members get their needs met? The truth is that all the COHO CCOs are incredibly dedicated to shifting our definition of health to include the food you eat, the air you breath, access to education, access to stable housing and food, access to transportation, and whether you face discrimination as factors that all significantly contribute to your health. Because AllCare and COHO are all seeking a shift in how we talk and think about health, we have strong, aligned policy priorities that help guide investments like these.

Our recent policy priorities have included ensuring that Oregonians on unemployment have access to healthcare during the crisis, increasing access to mental health services for children in schools, and our continued support of the expansion of telehealth. All these pieces are part of a strategic, member-centered plan to help the state through crises, and continue to improve our CCO model.

Affordable housing advocates have been working with legislators for years to craft state policies to meaningfully address housing affordability and access to affordable housing. Without attempting to grade past performance in this area, it is safe to say there is still work to be done in this policy area.

In this fourth installment in our COHO Health Equity series, we spotlight COHO member Trillium Community Health Plan investments to address housing and food security concerns for Oregon Health Plan (OHP) Members that they serve. Trillium Community Health Plan serves the Lane County and Springfield areas, which holds Eugene, a city ranked in the list of Top 10 cities with the biggest housing crunch, but many rural communities Trillium serves are also experiencing the same problem.

Lack of housing availability tends to be thought of as the problem of large metropolitan cities, but the reality is that average rent costs exceed average/median income levels throughout the state, and the inequality is often most pronounced in Oregon rural communities. People also tend to think of COVID-19 in terms of its infection rate, hospital capacity, and availability of personal protective equipment, but it exacerbated many social determinants of health in significant ways.

Massive layoffs combined with the Employment Department’s failure to provide unemployment relief in a timely manner have resulted in loss of income for hundreds of thousands of Oregonians, both widening the disparity between income coming in and rent going out, and amplifying the prevalence of food insecurity for low income families and the working poor.

We know that the COVID-19 pandemic has had disproportionate impacts on African American communities, Asian and Pacific Islander communities, Native American communities, and Latino, Latina, and Latinx communities. These are communities that  already face increased barriers to basic tenets of livelihood and may not have access to some of the resources provided through this pandemic, like the Federal stimulus check of $1,200.

Trillium has long been dedicated to breaking down barriers that cause health inequities by focusing programmatic investments on the social determinants of health, like housing and food security. Because of their experience with addressing social determinants of health, during the COVID-19 pandemic, Trillium was able to quickly identify areas of need in their community and take action to address those needs.

Food Security: 

In response to food security needs, Trillium donated nearly $2,000 worth of Walmart gift cards to a nonprofit organization called Centro Latino that offers a variety of services to families ranging from crisis intervention to job search assistance, and include connecting members with rent assistance. David Saez, Executive Director of Centro Latino said, “Thanks to this donation, we will be able to help children and families who are struggling to get their basic needs met during this difficult time.” 10 other organizations that work with unhoused youth and many others also received a large donation of Wal-Mart gift cards to ensure Oregonians have access to basic necessities.

What about those that do not have access to a Walmart? Trillium recognized that many of their more remote OHP members living in rural areas may not be able to utilize these gift cards. Instead, they distributed about $5,000 worth of Amazon gift cards between six rural, community-based organizations in Oakridge, Cottage Grove, Florence, Reedsport, McKenzie Bridge, and Harrisburg that help to address the needs of those living in rural poverty. Now, Oregonians with access to these gift cards will have the ability to order cleaning supplies, safety gear like masks, and many other necessities while remaining safe in their homes.

Housing Concerns: 

To address housing concerns, Trillium donated $5,000 to Safe Place Family Justice Center, a nonprofit in Clackamas County, Oregon that focuses on providing housing and housing supports for women and families. Because instances of domestic violence are increasing across the nation during COVID-19, and many are in unsafe housing, Trillium also donated $5,000 each to The Relief Nursery & Womenspace, two organizations that aid people in domestic violence situations.

Trillium knows that health is not just seeing your doctor when you are feeling under the weather. The food you eat, the air you breathe, your access to stable housing and food, access to transportation, and whether or not you face discrimination (among many other things) are all factors that significantly contribute to health. By considering these different areas as health care issues, and investing in them, we can increase positive health outcomes for Oregonians and spend less money on health care.

COHO CCOs have strong, aligned policy priorities that seek to decrease barriers and discrimination in health care that help guide our programmatic investments. While our CCOs put policy priorities like breaking down language barriers and increasing housing security into place on the ground, our government affairs team is working hard to pass even more legislation to address health inequities. Our priorities, like promoting social determinant of health spending and instituting protection of those investments, increasing value-based payments to providers, fighting OHP provider reimbursement cuts, and many more, are all part of COHO’s plan to make Oregon’s public health care system a model that people across the nation will look to for guidance.

Join us in ensuring Oregonians have the access to the equitable health care that they deserve.

Thank you Trillium, for leading the way in dismantling health equity barriers in our state.

We are incredibly excited to share the third feature of our health equity series! Last Month, Cascade Health Alliance announced a significant investment in Klamath & Lake Community Action Services (KLCAS), a nonprofit that assists individuals who have been financially impacted by the pandemic. KLCAS’ services to Oregonians include assistance with rental paymentsutility paymentsparenting supports, and more.

Cascade Health Alliance has long been dedicated to breaking down barriers that cause health inequities by focusing programmatic investments on the social determinants of health. These determinants, like stable housing, food security, access to transportation, connection to support systems and community, fit a new idea of what “health” is. This idea of health truly encompasses the full systemic view of a person’s life, and how other factors affect their health.

We know that across Oregon, hundreds of thousands of people have been laid off or furloughed without pay, and therefore have lost their health insurance. Additionally, they may have medical bills from contracting COVID-19, which leaves little to no room to continue to pay rent, buy groceries, and afford basic necessities. Even worse, our unemployment system is falling behind due to the staggering number of claims, leaving many without unemployment insurance for months. In a message from Director Pat Allen of the Oregon Health Authority, he shared that the COVID-19 pandemic has had disproportionate impacts on Black and African American communities, Asian and Pacific Islander communities, Native American communities, and Latino, Latina, and Latinx people in Oregon. When our communities are hurting, it is our job to ensure that they are cared for.

Because Cascade Health Alliance knows that health is more than just ensuring you see your doctor at regular intervals, they made the decision to invest $50,000 in KLCAS so they could continue to provide basic necessities to Oregonians who may not be able to afford them right now. The donation provided by Cascade Health Alliance was used as matching funds by KLCAS to secure an additional $198,738 for rent relief funding through COVID-19 CARES Act funding.

Tayo Akins, Cascade Health Alliance CEO, stated, “There is a tremendous need for organizations like Klamath & Lake Community Action Services right now. With more of our neighbors losing their jobs and uncertain about their futures, now is the time to step up and support agencies that extend a firm hand of relief. KLCAS had been one of them for a long time, and we appreciate their hard work to help those most in need.”

This dedication to dismantling health inequities before, during, and after COVID-19 does not just benefit Oregonians receiving rental assistance, utility assistance, childcare assistance, as well as stellar health care coverage. When we provide the support that Oregonians need to keep them safe and healthy, we save the state and all Oregonians money, because fewer people end up in the Emergency Department.

Have you been wondering how COHO CCOs are able to make quick decisions on dynamic investments in key areas across the State, while still focusing on the needs of their community? COHO CCOs all have strong, aligned, policy priorities that include their dedication to decreasing barriers and discrimination in health care. These policy priorities guide not only our government affairs teams in working with legislators and other public officials on passing legislation that protects Oregonians on the Oregon Health Plan (OHP), but also guides our CCOs in making programmatic investments. We look forward to continuing our health equity series, in which we share the stories of our CCOs working together across the state, to ensure that OHP members are getting the care that they need on the ground, and the advocates they need at the Legislature.

Thank you, Cascade Health Alliance, for continuing to lead the effort in building and maintaining healthy communities! To read Cascade Health Alliance’s press release on the topic, click here.

This Monday, two members of the Coalition for a Healthy Oregon testified to the Senate Health Care Committee on their provider support strategies during the COVID-19 pandemic. Dr. Jeanne Savage, Chief Medical Officer of Trillium Community Health Plan, and Will Brake, the Chief Operating Officer of AllCare Health represented our association to the Senate Health Care committee, sharing succinctly the many different innovative solutions our CCOs have dreamt up to help keep provider doors open through this crisis.

Dr. Savage testified on her perspective as a physician herself, sharing that her role as a provider helped her see the needs in the community, because she saw them in her own practice. She detailed some of the many investments Trillium has made in their community to ensure that providers were able to maintain staffing capacity and see OHP members. Will Brake followed Dr. Savage, detailing the interpreter services delivered by AllCare, and putting an incredible fine point on the fact that AllCare (like many CCOs) also pay providers a monthly rate instead of per-member reimbursement for services.

A few days before the committee hearing, Brian Neuubert, the Legislative Policy and Research Office (LPRO) Analyst for the Senate Health Care Committee reached out to request COHO’s help in finding members of our CCOs to testify on CCO provider supports.

COHO got to work brainstorming a representation that would share both an urban and rural perspective, so legislators could have a clear understanding of what is happening on the ground. Trillium Community Health Plan was excited to share the many ways they have been aiding providers, and identified Dr. Jeanne Savage, both the CMO and a provider that serves Trillium as the perfect person to deliver our message.

AllCare Health was equally excited to join in on the conversation, and helped us determine that Will Brake, the COO and member of the Metrics and Scoring Committee run by OHA, would be another amazing messenger.

Thank you for your willingness to participate, and your wonderful representation of both rural and urban CCOs.

To read more about investments made by Trillium Community Health, click here. To read more about investments made by AllCare Health, click here.

Trillium

AllCare

At the outset of Oregon’s coronavirus outbreak, Gov. Kate Brown issued sweeping executive orders to help “flatten the curve” and preserve health system capacity. One of these orders was a ban on non-urgent medical procedures, which has since been lifted.

Gov. Brown and her medical experts have encouraged people to seek the health care they need. Nevertheless, the volume of activity has not returned to normal (this could be for a variety of reasons, such as folks worrying about contracting COVID-19 or spreading it to others). While necessary in the early weeks of the pandemic, the ongoing slowdown has meant a major decline in revenue for many providers. Most importantly, there are concerns that deferred care could lead to worsening of certain health conditions.

In the months ahead, health care professionals expect a surge in demand for preventive care, dental care, elective surgeries, and other services. This begs the question: what effect will this have on our Medicaid system?

Throughout the pandemic, CCOs have been helping providers, clinics, and other health care providers keep their doors open and maintain capacity by delivering financial support. However, CCOs’ global budgets do not necessarily take into consideration the multi-month global pandemic we are currently going through.

Many of the providers who serve Medicaid patients are reimbursed through sub-capitated payments (per member per month). These payment arrangements could help level off the peaks and valleys of utilization, as well a potential future surge in demand. Nevertheless, there is little reason to believe the decline in utilization during the second quarter will lead to any real “savings” by the CCOs. This is especially true when considering the potential spike in activity and the progression of certain conditions due to the interruption in care.

In order to responsibly plan for the medical surge that may lie ahead, CCOs are focused on coordinating care for members and keeping their partners, the provider community, in business. It remains to be seen how the system will be impacted in the long run, but CCOs are well positioned to handle these irregularities while providing excellent health care to Oregon Health Plan members.