In 2017, Oregon executed a five-year renewal of its 1115 Medicaid waiver with the Centers for Medicare & Medicaid Services (CMS), extending the demonstration period through June 2022. Under the renewal, the state:
- Continued with the goals of the 2012-2017 Coordinated Care Organization (CCO) model, including a commitment to limit increases in per capita spending and improve health care access and quality
- Included a strengthened focus on integrating physical, behavioral and oral health care
- Encouraged more significant investments in health-related services (HRS), previously known as “flexible services,” to address social determinants of health (SDOH)
- Established that Medicare and Medicaid dually eligible individuals could be passively enrolled by the state into a CCO, moving from an “opt-in” to an “opt-out” model
CHSE assessed data from 2011-2019, capturing the initiation of Oregon’s CCO model under the 2012-2017 waiver and including three years under the renewal (2017-2019).
Between 2016 to 2019:
- Emergency department (ED) visits for members with behavioral health conditions declined by 10.6%
- ED visits for non-traumatic dental conditions decreased by 17%
- The percentage of children aged 6-14 receiving dental sealants on permanent molars increased from 16.5% to 20.4%
- Behavioral health outpatient visits for dual-eligible members increased. However, the study could not determine the impact of passive enrollment because data on dual-eligible members was only available through 2018.
These results show progress during the demonstration period, but caution in interpreting these results is warranted. Changes in these measures may result from policies and programs outside of this demonstration. The evaluation noted particular concerns about the lack of progress on some measures of behavioral health integration. Additionally, the assessment did not include performance under new CCO 2.0 contracts effective in 2020, nor did it assess the impacts of the COVID-19 pandemic.
About the Center for Health Systems Effectiveness
The Center for Health Systems Effectiveness researches health care service delivery with the aim of improving the value and sustainability of the U.S. healthcare system. Our mission is to provide the analyses, evidence and economic expertise to build a better and more sustainable health care system.
To learn more about the CHSE, visit us on the web or email us at CHSE-info@ohsu.edu.