While Oregon Medicaid Teeters on Collapse, Safety-net Clinics Outperform the Entire System

Recently I did some analysis of Oregon's Cost Growth Target (CGT) data to see how Oregon's community health clinics compare to other larger health systems and private provider groups.

The results honestly blew my mind...

According to OHA's latest CGT report, FQHCs accounted for 63% of all primary care organizations that met the cost growth target despite only making up about 20% of primary care practices statewide.

The average cost growth rate among all other provider groups was 6.5%. The FQHC average? 2.7%.

It got me thinking about what makes FQHCs so cost-effective, especially considering most have more complex patient populations.

I wondered why more state leaders aren't busting down doors to get their insights. Last I checked, the entire CCO model was facing a budget crisis like never before... And this is before any of the devastating effects of H.R.1 take effect.

As Oregon's CCO model faces the most financially unstable period in its history, I gotta say… I’m not sure we’re asking the right questions.

State health leaders and insurance executives are quietly pointing to the need to cut payments to Medicaid providers, cut benefits to Oregon Health Plan members, limit who is eligible, and divest from equity and social needs programs. The typical austerity measures you'd expect.

But here's the kicker... they're also cutting the core components that made up the original promise of the coordinated care model.

The CCO Quality Incentive Pool. You know, the one that’s used to support providers who deliver high quality care... reduced by tens of millions.

CCOs are cutting behavioral health provider contracts at a time when our children and families have growing need.

And they’re pointing to their own failed attempts at value-based reimbursement as a reason to cut most VBP contracts entirely.

Meanwhile, OHP members are forced to wait longer and longer for the care they desperately need.

So, perhaps there are different questions we should be asking...

I can think of a few:

• Are Oregonians getting enough value relative to the CCO administrative cost?

• With huge tech advancements, how much of today’s CCO infrastructure can be automated?

• Can OHA's MMIS & fee-for-service infrastructure be leveraged to centralize provider enrollment, PCP assignment, claims adjudication, and other core processes?

• Which CCO functions are worth salvaging?

I’m not suggesting FQHCs are perfect. But the providers consistently delivering advanced, cost-effective care should probably have a far greater voice in determining where Oregon goes next.

Especially if they’re the ones keeping the ship afloat.