Oregon Medicaid Demonstration Project
Oregon’s Medicaid program, known as the Oregon Health Plan (OHP), is implemented through the Oregon Health Authority’s (OHA) Health Systems Division. To ensure better health and coverage for Medicaid recipients, Oregon created coordinated care organizations (CCOs) in 2014. CCOs, which are similar to accountable care organizations, are collaborations among communities, health care providers, health plans, and hospitals, intended to integrate physical, behavioral, and oral health care under global budgets that incentivize value-based service delivery and patient outcomes for OHP members. CCOs are focused on prevention and helping people manage chronic conditions, such as diabetes, and address chronic disease risk factors. As of December 2018, 571,406 adult Medicaid beneficiaries were OHP members and enrolled in either fee-for-service or one of 16 CCOs.
Oregon implemented the Medicaid Coverage for the National Diabetes Prevention Program (National DPP) Demonstration Project through OHA’s Health Systems Division and Public Health Division. The structure of the Demonstration in Oregon brought together the Health Systems Division’s focus on preventive services and the Public Health Division’s community collaborative infrastructure, the Sustainable Relationships for Community Health (SRCH) model. The SRCH model, used by OHA to advance local health system interventions and promote community‐clinical linkages at the county level, is organized around local public health, CCOs, tribes, clinics, and community-based organizations.
Three of the state’s 16 CCOs (as of 2016) participated the Demonstration to deliver the National DPP lifestyle change program to their Medicaid recipients at risk for type 2 diabetes. The CCOs included FamilyCare Health (FamilyCare), Health Share of Oregon (Health Share), and Trillium Community Health Plan (Trillium). In January 2018, FamilyCare closed its Medicaid managed care plan, and all beneficiaries were transferred to Health Share or other CCOs. Beneficiaries who had been part of the Demonstration through FamilyCare that were transferred to Health Share were able to continue participation in the National DPP lifestyle change program through the same CDC-recognized organizations.
Figure 1. Organization of Oregon’s Medicaid Demonstration Project (Year 2)
2. Family Care discontinued its Medicaid-National DPP on February 1, 2018.
3. Omada only has one organizational code, even though it works with multiple MCOs and CCOs across states.
4. African American Health Coalition discontinued its portion of the Demonstration; the lifestyle change program participants from this organization completed the classes at the Miracles Club of Portland.
CCOs’ global budgets enable them to use flexible funds and administrative dollars to provide funding to the community to implement evidence-based programing. For the Demonstration, they distributed the grant dollars to community partners to deliver the National DPP lifestyle change program in their service areas. FamilyCare and Health Share used the same CDC-recognized organizations, including the Asian Health Services Center, the African American Health Coalition, the YMCA of Columbia-Willamette, and Lifestyle Medicine Group. In March 2018, the African American Health Coalition closed its doors. CCO members from Health Share and FamilyCare who participated in the Demonstration were transitioned to the Miracles Club, a nonprofit community-based organization serving the African American community in the Portland Metropolitan area. In addition, Oregon Health & Science University’s (OHSU’s) Harold Schnitzer Diabetes Health Center provided a Spanish-language class in Clackamas County for Health Share and FamilyCare members. Health Share and FamilyCare also offered online delivery of the National DPP lifestyle change program through Omada. Trillium Community Health Plan delivered the National DPP lifestyle change program to members in Lane County by offering the program in-house (i.e., Trillium became a CDC-recognized organization) and through the Eugene Family YMCA. In addition to providing a Spanish-language National DPP lifestyle change program (Tuality Healthcare) to Health Share, the Harold Schnitzer Diabetes Health Center at OHSU provided training and technical assistance to CDC-recognized organizations and assisted Health Share with recruitment of eligible Medicaid beneficiaries. The Coraggio Group, a Portland management consulting group, provided coaching and technical assistance to state agencies, CCOs, and other local SRCH partners involved in the Demonstration. The Coraggio Group played an integral role in the annual SRCH institutes, which brought together local SRCH partners involved in the Demonstration as well as other CCOs engaged in related work in chronic disease to develop strategic plans, integrate systems, and share lessons learned.
As of June 2016, FamilyCare provided OHP coverage in four counties: Clackamas, Multnomah, Washington, and parts of Marion. FamilyCare had approximately 130,000 OHP recipients in these counties. Health Share had a similar geographic coverage area that included Clackamas, Multnomah, and Washington Counties, with approximately 236,000 OHP members. Trillium covered Lane County, with approximately 100,000 OHP members.
Figure 2. Oregon Counties Targeted in the Demonstration
To learn more about outcomes from the Demonstration, please visit the Evaluation page. Oregon created guides for their CCOs to successfully implement the National DPP lifestyle change program, please find those here.
Oregon’s Health Evidence Review Commission (HERC) recently approved covering the National DPP lifestyle change program as a Medicaid benefit, effective January 2019. In addition, OHA has been working on health care provider outreach since mid-2018 to prepare for the roll-out.
The HERC decision means the National DPP lifestyle change program will be covered as a medical benefit and placed on HERC’s prioritized list of Medicaid covered services. All of Oregon Medicaid’s fee-for-service health care providers and CCOs will be required to cover the benefit and will be reimbursed for the program. CCOs are waiting to see how the benefit is defined and will play a significant role in promoting Medicaid beneficiaries’ access to the benefit.
OHA also plans to provide support and technical assistance to all CCOs as they implement the National DPP lifestyle change program through the agency’s transformation center. The SRCH initiative will remain the resource for bringing together local entities to continue to streamline and work on getting program referrals and community organizations set up to accept reimbursement. In addition, OHA plans to continue having OHSU conduct lifestyle coach training across the state.
To learn more about Oregon’s National DPP lifestyle change program benefit please visit the Oregon Health Authority: National Diabetes Prevention Program webpage.
Content last updated: October 1, 2019