Oregon’s reformed Medicaid program has largely worked as intended with its coordinated care organizations performing well during the first three years of the federal waiver, according to researchers.
The framework for the Oregon Health Plan was adopted in 2012 under a Medicaid waiver, and it provided each of the 16 regional care organizations with a single pool of money to cover member health care needs, The Bulletin reported.
The new model localized funding allocation decisions and offered incentive payments to care organizations that improved specific outcomes.
Under this model, plan members have reported better care experiences and improved health, according to a report made public Monday by the Oregon Health & Science University.
The care organizations have generally improved on many quality measures with greater gains reported in the areas incentivized by the special payments, according to the report.
While the new system saw improvements, access to health care saw a decrease. Researchers attributed the decrease to an influx of new members caused by the 2014 Medicaid expansion.
Under the waiver, Oregon capped health spending growth rates at 3.4 percent per year for care organizations’ budgets.
“They got lucky there because there was kind of a national slowdown,” said Dr. John McConnell, the principal investigator for the report. “The next five years will probably be more challenging, because it’s easier to save money when you’ve got slack in the budget and they clearly did.”
None of the care organizations had negative margins in 2014, but three lost money by 2016. Family Care, a Portland area care organization, lost about $23 million that year, causing it to shut down at the end of January.