Is Oregon's Medicaid reform plan working? 4 things to know

Reforms intended to integrate care and save money in the Oregon Health Plan, the state's $6 billion Medicaid program, have produced mixed results in the first five years, according to the Portland Tribune.

Pushed through by former Democratic Gov. John Kitzhaber, MD, the reforms combined physicians, hospitals, local care companies and payers into coordinated care organizations. These CCOs integrated physical, mental and dental health in an effort to curb costs and improve the quality of care, according to the Portland Tribune, which is looking at the Medicaid reforms in a series of reports.

Here are four key takeaways from the first report in the series:

1. A state-funded report, conducted by Portland-based Oregon Health & Science University, found the reforms improved care quality and reduced the overall amount the state pays to care organizations for the plan. The OHSU report found the amount the state paid over the past five years stayed at or below 3.4 percent growth, which was the spending cap, according to the report.

2. The Portland Tribune found new internal state records that show the cost of per-member care provided by the CCOs has increased by between 6.7 percent and 8.7 percent every year since 2014, when Medicaid expansion dramatically increased enrollment in the program.

3. The cost increases are driven largely by drug price hikes and hospital costs, according to the report.

4. Some of the nonprofits involved with the CCOs are reporting significant losses due to the reforms. CareOregon, one such nonprofit, reported what the Portland Tribune calls "massive" operating losses in 2017. Another nonprofit, Family Care, stopped serving Medicaid beneficiaries because it couldn't sustain the losses and has sued the state for higher reimbursement, according to the report.

Read the full article here.


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