FamilyCare may have capitulated to the state’s demands and ended litigation, but its troubles with the state over fair payments may just continue, as the Oregon Health Authority has proposed giving the Portland-area coordinated care organization by far the lowest quality pool payments per member in the state.
FamilyCare is set to receive $19.1 million, or $148 per member. The average payment for the 16 CCOs is $184 per member while Yamhill CCO received the next-lowest payment at $162 per member, or about $4 million for its 25,000 members.
The quality pool, which totals $168 million for all 16 CCOs, comes from a 4 percent holdback in the Medicaid dollars that fund the organizations. The money is then given back to them based on how they fare according to a byzantine formula drawn from a set of quality control metrics.
Under a recent legal settlement, the Oregon Health Authority agreed to drop its threat to terminate FamilyCare’s contract if the CCO would drop all litigation against the state, but the quality pool payments were not at debate in those disputes.
“The intent was to keep the [quality pool payments] separate from the litigation,” said Cindy Becker, the spokeswoman for FamilyCare. “One should have no impact on the other.”
The Eastern Oregon Coordinated Care Organization and the two Coast-based CCOs were the biggest winners in this year’s quality pool disbursements, with each expected to get more than $200 per member, with Eastern Oregon topping the list at $212.40 per member, or $10.2 million to serve 48,000 people.
Columbia Pacific, at $211.70 per member was a mere 70 cents behind, however, on a per capita basis. The Astoria-based CCO would earn $5.6 million across 27,000 members, according to preliminary numbers. Western Oregon Advanced Health is poised to get $4.3 million, or $209 per member. The Coos Bay CCO has almost 21,000 members.
The preliminary numbers were obtained by The Lund Report ahead of the authority’s official release at the end of this month. Oregon Health Authority spokeswoman Alissa Robbins stressed that the numbers were just potential payments and had not been finalized.
FamilyCare’s competitor, Health Share of Oregon, received the highest total bonus -- $42.4 million -- but was in the middle of the pack on a per capita basis, as was Trillium Community Health in Eugene now owned by Centene Corporation, a Fortune 500 company. Both are set to earn about $182 per member.
The other large CCO, Willamette Valley Community Health in Salem, was also toward the bottom, earning just $172 per member, for a total of $17.3 million.
Good Formula Not Obvious
For 2015, four metrics were weighted heavier than the others: depression screening and follow-up; diabetes control; alcohol and substance abuse screening; and developmental screenings.
The Oregon Health Authority published mid-year results in January on where the CCOs stood on some of their 17 metrics, but there was no obvious connection between a good performance based on that report and a high bonus payment from the complicated formula used to allocate funds. Numbers for the depression and diabetes metrics were not included in that report.
In the mid-year report, FamilyCare reported the lowest rates of hospital admissions for preventable conditions, including the lowest rates for asthma and chronic obstructive pulmonary disorder. It had the second-best immunization rates for adolescents at 76 percent, the second-best improvement in the use of electronic medical records and the third-best improvement on the follow-up on people who’d been hospitalized for mental illness.
Its low marks were a low rate of outpatient utilization and the lowest rate of contraceptive use for women. FamilyCare showed the sharpest decline in adolescent well visits, but still led the state on that metric.
The Eastern Oregon CCO showed the highest growth in the percentage of members enrolled in primary care homes, from 61 percent to 74 percent. Columbia Pacific showed the most improvement in the use of electronic health records, from 57 percent to 72 percent. Western Oregon Advanced Health had the highest use of contraception among teenage girls, 43 percent.
But if the Coos Bay CCO scored well at preventing teenage pregnancy, it scored poorly at preventing communicable diseases. Western Oregon had the lowest vaccination rates by far -- just 55 percent for young children and 35 percent for adolescents.
Meanwhile, Yamhill CCO had shown the highest rate of avoidable emergency department use. Willamette Valley had the worst rate of follow-up after hospitalization for mental illness at just 60 percent. Yamhill was highest on that measure at 78 percent.
