In response to the Governor’s June 2013 request, the Oregon Health Policy Board (OHPB) recommended strategies and actions to align the Affordable Care Act implementation with Oregon’s health system reform. Among these recommendations, the OHPB called for the spread of the coordinated care model (CCM) to the broader market by aligning coordinated care model principles across payers and achieving organization alignment around those principles.
To fulfill that request, the Oregon Health Authority (OHA), the Public Employee Benefits Board (PEBB) and the Oregon Educators Benefits Board (OEBB) created the Coordinated Care Model Alignment Workgroup. The Workgroup met from 2014-2016 and was charged with developing a host of tools to assist in the implementing CCM principles across multiple market segments.
Tool Kit
The Workgroup conducted an environmental scan and developed a tool kit to assist purchasers, carriers and consumers to understand each element of the CCM. The toolkit provides resources and tools to assist in the adoption and implementation of the CCM. The environmental scan report and the components of the toolkit are available below:
Environmental Scan Findings
The Workgroup's Environmental Scan Report aims to develop a more comprehensive picture of Oregon’s health insurance market and existing programmatic and operational efforts to adopt the CCM. The Oregon Health Authority, with support from Bailit Health Purchasing, interviewed carriers and purchasers throughout the state. The information helped the Workgroup define tools that might be helpful to purchasers and carriers thinking about adopting CCM components and for consumers seeking to understand the model.
Communications Tool
Oregon's CCM Communications Tool describes the Coordinated Care Model and its importance to purchasers, employees and carriers. describes the Coordinated Care Model and its importance to purchasers, employees and carriers.
Framework for Procurement and Contracting
The Framework for Procurement and Contracting is designed to be used by purchasers for self-insured products but can also be used for fully-insured plans. The document "Operationalizing the Principles of Oregon’s Coordinated Care Model: A High-Level Framework for Procurement and Contracting" serves as a roadmap for purchasers looking to incorporate the CCM components into their benefits purchasing. The framework focuses on concepts tied to the CCM principles and identifies operational elements at the plan and provider level to form an applied set of strategies to transform care delivery. The framework highlights the critical elements of the model and offers specific measures or targets that could be adopted to encourage progress towards transformation of specific areas (e.g., PCPCH, team-based care, Alternative Payment Methodologies).
Model Contract
The purpose of the draft Model Contract is to assist self-funded employers in implementing CCM elements through an agreement with a Third Party Administrator (TPA). Most of the model contract language could also be used by fully-insured employers in agreements with health insurers and by multi-state employers. The concepts of the CCM are not unique to Oregon and are being implemented nationally by employers. The model contract does not include language on standard administrative services and employers will have to work with their TPA to ensure that the information is incorporated since it would be required in a contract. The model contract assumes that these employers have a comprehensive benefit package that exceeds what is in Essential Health Benefits and doesn’t provide details on what would be included. Recognizing that purchasers will be in different places and comfort levels with some aspects of the CCM, there are a number of elements marked “Alternative” or “Optional,” throughout the contract.
Fact Sheets
The Workgroup developed three fact sheets to assist purchasers and carriers in understanding specific concepts of the CCM. The fact sheets describe the importance of adopting and implementing key pieces of the CCM, including payment reform and PCPCHs, to achieve transformation that results in better care, better health and lower costs.
Finding a Coordinated Care Health Plan for Your Employees
The document "Finding a Coordinated Care Health Plan for Your Employees" is a checklist intended for employers seeking to incorporate elements of the CCM into their existing or future plan for their employees. When speaking to a broker or carrier, the purchaser can use it as a guide to inform the benefits purchasing process.
In Conclusion
Additional messaging and communication strategies for specific groups, including brokers and employers will be added to this toolkit as they are developed.
Work Group Information: