The coordinated care organization that serves Central Oregon’s Oregon Health Plan members met more quality measures in 2017 than any other Oregon CCO, according to a state report released Tuesday.

The Oregon Health Authority retains 4.25 percent of its monthly payments to CCOs to create a $178 million quality fund, which is used to reward the regional organizations for their performance based on 17 quality measures. The Central Oregon CCO, run by PacificSource Health Plans in cooperation with the Central Oregon Health Council, met 16 of those metrics, earning $10.5 million in bonus payments.

CCOs can meet the requirement either by meeting a national benchmark or by a hitting an improvement target, usually a 3 percent increase over the previous year.

PacificSource narrowly missed meeting its target on one metric, emergency room utilization, which rose to 43 visits per 1,000 members per month in 2017, just a shade over the 42.9-visit benchmark.

“The one we missed was a very frustrating miss, a very small margin,” said Leslie Neugebauer, Central Oregon CCO director at PacificSource. “Every year, the improvement target goes down, so every year it gets harder.”

Emergency visits in 2016 may have been lower due to a tough winter that kept potential patients at home. But a bad flu season this past winter produced more ER visits.

The CCO is doubling down in 2018 on its efforts to reduce unnecessary emergency room use, focusing in particular on hospitals in Madras and Prineville.

The Central Oregon CCO hit the national benchmark on 10 of the 17 measures.

That included assessing more than 90 percent of children in foster care.

“Obviously that is a very vulnerable population that we want to wrap around services for, but that’s a hard measure,” Neugebauer said. “They have to have their dental, physical and mental health appointments within 60 days of being in foster care, and if you miss even one of those appointments, you don’t get credit.”

The Central Oregon CCO had the highest rate of effective contraceptive use for adults of any CCO in the state and made significant strides on a child immunization measure. That’s due in part to a grant the health council issued to Deschutes County Health Services to implement a targeted vaccination effort throughout the tri-county region. That improved immunization rates for children up to 2 years old from 66.8 percent in 2016 to 73.2 percent in 2017, a 6 percentage point increase in a state with pockets of significant vaccine resistance.

“They really did some incredible work,” Neugebauer said. “We’re still little bit off from the benchmark, but only a few CCOs met that benchmark.”

That’s exactly the way Oregon officials had designed the program to work, with CCOs collaborating with community partners to improve the health care of their communities and lower the cost of care. With improvement targets increasing every year, the system is slowly raising the quality of care up to national benchmarks.

“What we’ve seen over the past five years is that incentives work,” said Jeremy Vandehey, director of health policy and analytics for the Oregon Health Authority. “They are driving improvements in the care that Oregonians receive and helping to improve the health of our communities.”

Statewide, 14 out of 16 CCOs earned 100 percent of their quality pool dollars. Unearned funds were used to reward CCOs that scored well on three challenge pool metrics. As a result, the Central Oregon CCO earned 101.2 percent of its quality pool dollars.

Sixty percent of the quality incentive bonuses will go into the CCO’s global budget, which is used to pay health care providers. The remaining 40 percent will go into a community fund for projects to improve the health of the community. In 2018, that will include funding two multimillion dollar grants focusing on integrating behavioral health services into primary care practices, and to a quality incentive program for local clinics.

The quality metrics approach is designed to reward regional organizations for good outcomes rather than paying for the number of services provided. State officials are now discussing ways to increase the use of that approach, including requiring CCOs to include such quality-based payments in their contracts with doctors and hospitals.

CCOs did better in 2017 at providing adolescent well-care visits, assessments of children in foster care, colorectal cancer screenings, developmental screenings and contraceptive use. They lagged behind on measures of postpartum care, alcohol and drug treatment, and hospital stays for congestive heart failure and short-term diabetes complications.

—Reporter: 541-633-2162, mhawryluk@bendbulletin.com