Oregon’s Medicaid Coordinated Care OrganizationsSeq ID: 401
Authors: McConnell, KJ
Website link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939819/pdf/nihms799531.pdf
Publicly Available: Yes
Billing and Reimbursement:
Policy: MCO contract language and reimbursement models
In 2012, the state of Oregon transformed its Medicaid program by establishing 16“coordinated care organizations,” or CCOs, to provide comprehensive care for its Medicaid population. Coordinated care organization scan be considered a type of accountable care organization (ACO): they are locally governed; are accountable for access, quality, and health spending; and emphasize primary care medical homes. However, CCOs differ from most Medicare and commercial ACOs in their acceptance of full financial risk in the form of a global budget. Coordinated care organizations are also required to integrate financing and delivery systems for a broad scope of services, including mental health, addiction, and dental services. Approximately 90% of the state’s 1.1 million Medicaid enrollees now receive care through CCOs that take a variety of forms that reflect the local context.