All but one of the state’s 16 coordinated care organizations which provide services to Medicaid patients earned a profit last year, according to data released by the Oregon Health Authority.
State regulators have not enforced any regulation or guidelines on how much profit a CCO can garner or how they need to spend those dollars. That was made quite clear when Mark Fairbanks, chief financial officer of the Oregon Health Authority, which regulates the CCOs, spoke with the Eugene Register Guard last July after the Centene Corp., a Fortune 500 company, was preparing to purchase Trillium Community Health Plan, a for profit enterprise.
Last year, Oregon’s 16 CCOs walked away with $137 million in profits, which was a stark decline from 2014 when they reported profits of $230 million. To look at their entire financial picture last year, click here.
Yet, several CCOs saw their profits escalate in 2015 – among them Cascade Health Alliance, which reported $2.1 million for a whopping 240 percent increase, and Health Share of Oregon whose profits grew by 50 percent reaching $22.6 million, which were the highest in the state.
The for-profit CCOs include Eastern Oregon CCO, Primary Health of Josephine County, AllCare, Umpqua Health Alliance, and Western Oregon Advanced Health.
Here’s a look at how all the CCOs did last year:
- AllCare Health Plan, $3.2 million in profits, a 78% decline
- Cascade Health Alliance, $2.1 million, a 240% increase
- Columbia Pacific, $4.4 million, a 177% increase
- Eastern Oregon. $15.6 million, a 16% decline
- FamilyCare, negative $495,117, a 99% decline
- Health Share. $22.6 million, a 50% increase
- InterCommunity Health Network, $19.9 million, an 18% increase
- Jackson Care Connect, $9.9 million, a 30% decline
- PacificSource Community Solutions, $12.04 million, a 53% decline
- Primary Health of Josephine County, $579,736, a 35% decline
- Trillium Community Health Plan, $14.7 million, a 34% decline
- Umpqua Health Alliance (also known as Architrave Health), $10.8 million, a 33% increase
- Western Oregon Advanced Health, $1.4 million, a 16% increase
- Willamette Valley Community Health, $12.7 million, a 12% decline
- Yamhill Community Care Organization, $6.9 million, a 13% increase
FamilyCare Loses Money
Not only did FamilyCare lose $495,117 at the end of 2015, but it suffered another $10 million at the end of the first quarter, on March 30, according to Jeff Heatherington, CEO and president.
“Our profitability was cut to zero as a direct result of the rates that the OHA gave us last year,” he told The Lund Report. “And if we had signed the amendment they asked for, at the end of last August, we would have ended up losing $55 million. With that net loss, we would have been in danger of closing.”
Heatherington also defended the higher rates he gives to primary care physicians, despite being criticized by OHA officials, including its director, Lynne Saxton.
“They say we’re paying excessive amounts but we’ve saved that much money and a little more in reducing emergency room visits and specialty costs,” he said. “That’s what healthcare transformation is all about. And, we have much better access for primary care because of our payment rates. The experiment worked, and now we’re being criticized because it’s considered excessive.”
FamilyCare’s lawsuit against the OHA is now in negotiation, and Heatherington is hopeful of a favorable outcome.
Diane can be reached at [email protected].
