Umpqua Health Alliance, one of the first coordinated care organizations authorized by the Oregon Health Authority in 2012, received failing marks in four of six categories and was one of the four CCOs that only received a one-year contract.

The Oregon Health Authority announced its intent to award 15 contracts to coordinated care organizations for the Oregon Health Plan’s nearly 1 million members. Eleven organizations in the state were approved to receive five-year contracts, and four organizations are approved to receive one-year contracts for the next phase of health care transformation, known as CCO 2.0.

A coordinated care organization is a network of health care providers designed to provide care for patients under the Oregon Health Plan.

UHA, based in Roseburg, received passing grades for finance and delivery system transformation categories. But the Oregon Health Authority said UHA was failing in business administration, care coordination and integration, clinical service and delivery, and community engagement.

Dave Baden, chief financial officer for the Oregon Health Authority, said there were some deficiencies need to be addressed by the Umpqua Health Alliance as well as concerns about the application. He said the one-year contract gives the state agency the opportunity to work with UHA on a remediation plan. If the Roseburg-based organization shows it can meet the goals of CCO 2.0, UHA will be awarded the rest of the five-year contract. UHA’s contract will end Jan. 1, 2020.

In a statement to The News-Review, Umpqua Health Alliance CEO Brent Eichman sounded optimistic that the company would be able to make the adjustments to be able to reach the goals of the OHA in CCO 2.0.

“We will identify areas to address which will allow Umpqua Health Alliance the full five-year contract award, however, based on our past performance and the OHA’s evaluation, we know that can be accomplished,” Eichman said in the statement.

Baden said if UHA is unable to meet the standards during the timeline set by the state, the Oregon Health Authority will work on how to best meet the needs for Medicaid patients in Douglas County.

“If not, we’ll work closely with Douglas County to make sure that the needs of the members are met and to find a CCO to meet those needs,” Baden said.

He said there were a lot of areas where there just wasn’t enough information provided in the application response to make a good judgment on the Umpqua Health Alliance.

“We just want to be able to work and ferret out whether it was just not writing a good application or there are really more major concerns about Umpqua meeting the new policy goals,” Baden said.

There were 19 applications for CCOs and four of the applications were denied. The other three CCOs that received only a one-year contract were AllCare CCO, Inc., which includes a small portion of southern Douglas County in its coverage area, Cascade Health Alliance in Klamath County and Yamhill County Care Organization.

Eichman said it seems apparent that the large regional insurance carriers have fared better in the application process than the smaller rural community-based CCOs, including UHA.

“While that is a major departure from the original vision of what the community-based care delivery system was going to be in Oregon, we believe that our area will once again be served locally by those in the community that know the community,” Eichman said in his statement.

Successful awardees will sign their contracts in the fall, totaling more than $6 billion for the 2020 contract year.

Eichman said he felt the outcome of the remediation plan from the OHA will positively position the company for the next five years.

“Umpqua Health Alliance remains focused on providing the best care for its members and continuing its record of success improving care and containing costs,” he added. “We look forward to working with the Oregon Health Authority and securing the five-year contract in order to continue our service to our community.”

Reporter Dan Bain can be reached at 541-957-4221 or e-mail at dbain@nrtoday.com.

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Reporter

Dan Bain is the health reporter for The News-Review. He previously worked at KPIC and 541 Radio.

(2) comments

JamieS

For anyone enrolled with UHA or advocating for those that are enrolled with UHA, the only thing that is surprising about all this is that the state is actually paying attention and intervening. There are some individual providers that are good, competent providers. However, for the rest of them, they often times don't know what they are doing, have long waiting times between appointments, you can't get someone on the phone, and your provider changes on a regular, rotating basis. This is not good medicine and many of these clinics are either owned by UHA outright or they have some financial interest them. When your provider or their partners have a financial interest their patients outcomes and/or procedures, that inherent conflict of interest almost always results in poorer outcome for patients

BetsyC

In 2012, when UHA was formed, a group of concerned citizens created Oregon Patients Rights (OPRA) because of our concerns with the then failing of the two entities that created UAH, DCIPA and Mercy. We were concerned that these two lacked sufficient input from and care about the rights of patients. Fast forward and I am working to address health care access for our community's most vulnerable population:e medically fragile homeless who are not provided appropriate care and often denied the care they need due to their housing status. When you say coordinated care; I have to ask where that is actually happening? My experiences with these entities is that it is not.

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