Lower ER Use and Hospital Readmissions Reported for Oregon Medicaid Patients

The Oregon Health Authority‘s (OHA) fourth Health System Transformation report shows that coordinated care organizations (CCOs) within the state made progress for the first nine months of 2013 on key performance and cost measurements within Oregon’s Medicaid population. This progress included a 13 percent reduction in emergency room use, a reduction in hospitalizations for certain chronic conditions (18 to 36 percent), and an 8 percent reduction in hospital readmissions. At the same time, primary care usage by patients increased 18 percent, developmental screenings in the first 36 months of life increased 11 percent, and the use of electronic health records by providers increased 50 percent.

What Are CCOs?

Oregon CCOs are provider networks who work together in their local communities for people receiving health coverage under the Oregon Health Plan (OHP) (Medicaid). As of November 1, 2012, there were 16 CCOs in Oregon​, serving about 90 percent of OHP members.More than 600,000 Oregonians were enrolled in OHP in 2013. In 2014, more than 180,000 Oregonians became new OHP members.

Quarterly Reports

The OHA publishes quarterly reports showing quality and access data, financial data, and progress toward reaching benchmarks. The state tracks 17 CCO incentive metrics and 16 additional state performance metrics. It also tracks financial data, displayed both by cost and by utilization. By using quality, access and financial metrics together, the state can determine whether CCOs are effectively and adequately improving care, making quality care accessible, eliminating health disparities, and controlling costs for the populations that they serve.

The February 4, 2014 report compiles twelve months of statewide utilization and cost data and a single quarter (October – December 2012) of CCO-level cost and utilization data, both based on claims made for payments from the coordinated care organizations. The report also shows nine months’ worth of several statewide and CCO-level performance metrics. In the months to come, analysis on more metrics will be completed and published. The February report also shows baseline race and ethnicity data for performance measures. This information will help highlight areas of greatest disparity and potential improvement.

The OHA’s quality and access data is available by CCO and metric. Financial data is available by cost and utilization