CORE Research on Oregon CCOs

What is a CCO?
Coordinated Care Organizations, or CCOs, are Oregon’s most innovative new solution for improving health care while controlling costs.

CCOs are "umbrella organizations"—partnerships between doctors, hospitals, mental health providers, dentists, insurance companies, community services, and public health agencies. The CCO is given a set dollar amount (a "capitated payment") for a set of Medicaid patients. If they can provide quality care for patients and keep patients healthy for less than the amount that they are paid, then the CCOs can keep what’s left over. If it costs too much to care for the patient, the CCO is on the hook for the additional charges.

CCOs are also held accountable for meeting quality standards. In other words, the CCO model theoretically pays doctors to keep patients healthy, instead of paying doctors when patients are sick.

While there are regulations governing CCOs, the strategies they use for finding inefficiencies in the system, controlling costs, and providing better-quality care vary widely. These strategies are generated locally by the community partnerships that govern the CCO.  

Why is Oregon So Important?
In May 2012 Governor John Kitzhaber went to Washington D.C. to pitch his plan for Medicaid reform in Oregon. He told the Obama administration that he knew how to fix Medicaid in Oregon—but he’d need the money to do it.

Washington agreed to give Oregon $1.9 billion over five years to support the transition to a CCO model for Medicaid in Oregon. In return, Gov. Kitzhaber promised that the model would save the national Medicaid program $4.8 billion over ten years.

Oregon’s CCOs are a type of Accountable Care Organization (ACO), a model that is attracting interest from many states who are trying to reform their Medicaid programs. Oregon is one of the first testing grounds for the ACO or CCO model, so "all eyes are on us."

In the spring of 2013, Oregon began accepting applications for prospective CCOs. As of April 2013 there are now 19 CCOs in Oregon.

How is CORE Involved with CCO Research?
CORE has three major projects that will collect information about CCO transformation.

The CCO Evaluation Project
CCOs are supposed to reduce health care costs while improving the quality of care and the actual health of patients. But can they do it? This study builds the first-ever typology for characterizing CCOs, and it compares outcomes for patients of 13 different CCOs in Oregon. More

The Health Commons Project
Oregon’s Coordinated Care Organizations (CCOs) bring primary care providers together with behavioral and mental health providers, dentists and public health experts to provide care for the whole person. These partnerships have created opportunities for innovative projects to provide more coordinated care.

In this study, we look carefully at five local projects that unite the Portland-area health care system like never before.

Case Studies of CCOs
CCOs are local solutions to regional health challenges; since they’re local, they all look different. Nevertheless, all CCOs face one problem: how to weigh the interests of individual partner organizations against the interests of the CCO.

This study takes a closer look at the decision-making structures embedded within two of Oregon’s most promising CCOs.

For more information about CCOs in Oregon, check out the following resources:
CCO Oregon, an organization committed to sharing best practices for CCOs 
The Oregon Health Policy Board has news and information about CCO policy