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Oregon Health Authority Announces State's First Certified Coordinated Care Organizations

The Oregon Health Authority announced its approval of 11 organizations applying to become coordinated care organizations, the newly forming organizations that will completely change how Oregon Health Plan patients receive care.

Coordinated care organizations (also known as "CCOs") are the backbone of reforms made to the Oregon Health Plan that the Legislature set in motion with the passage of House Bill 3650 and Senate Bill 1580 in 2011 and earlier this year.

CCOs will integrate and coordinate each Oregon Health Plan patient's physical, mental and dental health starting this August. The hope is by creating patient teams of doctors, nurses, mental health practitioners, community health workers, dentists and various other health providers working with Oregon Health Plan patients, more efficient and effective care will be provided, thus saving costs and decreasing emergency room and specialty care use.

Approximately 650,000 Oregonians are covered by the Oregon Health Plan, and the 11 applications approved by the Oregon Health Authority propose to provide care in most areas of the state. The list of approved and rejected applications can be seen on the Oregon Health Authority website.

The 11 approved applications have been "provisionally certified," and their formal certification will depend on "additional information necessary to meet the core certification criteria that will be required from these applicants before contracts can be finalized," according to information on the Oregon Health Authority's website.

The organizations will now enter into contract negotiations with the Oregon Health Authority, and their applications must also be approved by the Center for Medicare and Medicaid Services (CMS). By the end of June, the Oregon Health Authority expects to have the contracts with the organizations finalized.

Four organizations were not approved. They have the ability to change their applications and resubmit them during a "second wave" of applications, due on July 1. What is significant about those disapproved applications is the service area they proposed providing care to--much of Oregon's north coast, including Clatsop, Columbia, Tillamook and parts of Coos and Douglas counties. Another disapproved application proposed covering much of rural, eastern Oregon, including Gilliam, Grant, Harney Lake, Morrow, Sherman, Umatilla and Wheeler counties.

But the Portland metropolitan area—which has the state's largest concentration of Oregon Health Plan patients, estimated at approximately 215,000--need not worry about whether it will have a coordinated care organization. The Tri-County Medicaid Collaborative, a large organization made up of the area's major hospitals, managed care organizations and other organizations, was approved.

Written by Amanda Waldroupe and reprinted with permission from The Lund Report.