To successfully improve the health care system, there are a few fundamental things that have to happen.
First, we have to have a joint agreement about what to focus on. Second, we have to measure how we are doing. And third, we have to be transparent so everyone can see what’s working and what's not.
Earlier this week OHA released the first annual report on the coordinated care model for the Oregon Health Plan. This report reflects those fundamentals.
The Health System Transformation 2013 Performance Report lays out how Oregon’s coordinated care organizations scored on health care service measures in 2013. These measures were selected through a public process in 2012. Additionally, this is the first report to show 2013 performance data by race and ethnicity compared to 2011 baseline data.
The report shows that patients and coordinated care organizations (CCOs) are starting to see the benefits of Oregon's new model for Medicaid. Although this is just the first year of data, the signs are promising. Emergency department visits have decreased 17 percent. Preventive screening for children increased 48 percent. There have been decreases in hospitalizations for chronic conditions and increases in primary care. It also shows us areas to focus on for improvement in the years ahead.
This data also is important because for the first time we are paying the CCOs based on how they performed on some of the improvement measures. Two percent of total payments were held back last year to create a quality pool. Based on how they scored on the measurements, this week CCOs will receive all or part of the payments that had been held back until now. To earn their full payment, CCOs had to show improvement toward the goals on 17 measures. All 15 CCOs showed improvements and 11 of them met 100 percent of their annual improvement targets. And what isn’t in the data are the real-life stories of what’s happening on the ground in communities – the innovations the CCOs are making and how people are coming together to provide better care that reflects local needs.
That said, the report also reflects where greater gains need to be made, such as screening for risky drug or alcohol behavior and whether people are able to get timely appointments with health care providers. Access to care is particularly important with more than 340,000 new Oregon Health Plan members joining the system since January of 2014. Some basic health screenings declined and we will work with the CCOs to learn more about that. We'll also be learning more about the areas where CCOs can improve and where we can improve as a state, and we'll be supporting CCOs through technical assistance, learning collaboratives and more.
We have only just started this work. In the years to come, there will be dips and rises in some of the measurements. And we will keep raising the bar so that we will have continual improvements. But having this information and providing incentives for better care are critically important to meeting the goal of shifting the health system to better serve us all.
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