Oregon has requested $1.25 billion in federal funding to expand the Oregon Health Plan (OHP), a coordinated care model implemented under Section 1115(a) of the Social Security Act. The current OHP Section 1115 demonstration waiver for coordinated care was approved in 2012 and is set to expire on June 30, 2017. The renewal request would extend the coordinated care model through June 30, 2022. Since the implementation of the coordinated care model, Oregon has reduced OHP’s per capita medical expenditure trend by two percent. By the time the current Section 1115 demonstration waiver expires in 2017, OHP coordinated care model expects to have saved the federal government $1.4 billion.
Under the current Section 1115 demonstration waiver, OHP has 16 coordinated care organizations (CCOs) that cover 90 percent of OHP members. The CCOs contract with providers that are organized into Patient Centered Primary Care Homes that offer teams of physicians, behavioral health specialists, nutritionists, and oral health providers under one roof. The CCOs have 17 incentive metrics to track how well they are improving care and are paid more when they meet these goals. Since 2011, emergency department visits by CCO members have declined by 39 percent and hospital admissions within 30 days of discharge for CCO members have declined by 33 percent. In addition, hospital admissions for CCO members for short-term complications associated with diabetes have declined by 29 percent.
In addition to expanding its focus on integrated health care and continuing to limit per capita medical expenditures, OHP would use the Section 1115 demonstration waiver renewal funding to address social determinants of health through the use of flexible services. These include home modifications, cooking classes for patients with nutritional issues, and group therapy for trauma survivors. Traditionally counted as administrative expenses, OHP’s demonstration waiver renewal application requests treating flexible service costs as medical expenses for rate setting purposes. The demonstration waiver renewal application is available here.
