Oregon

Chapter 595 of the 2009 Oregon Laws established the Patient Centered Primary Care Home (PCPCH) Program by the Office for Oregon Health Policy and Research . Through this program, the Office shall:

  • Define core attributes of the patient centered primary care home; 
  • Establish a simple and uniform process to identify patient centered primary care homes that meet the core attributes defined by the Office;
  • Develop uniform quality measures that build from nationally accepted measures and allow for standard measurement of patient centered primary care home performance; and
  • Develop policies that encourage the retention of, and the growth in the numbers of, primary care providers.

This law created a learning collaborative to assist practices in developing the infrastructure for PCPCH. The law also allowed for changes in payment for practices who provide care in medical homes including payment for interpretive services and rewards for improvements in health quality. The PCPCH program serves as the pathway for primary care practice participation in all patient-centered medical home related programs in Oregon including the Comprehensive Primary Care initiative, Coordinated Care Organizations, and 2703 Health Homes. 

Chapter 602 of the 2011 Oregon Laws established the Oregon Integrated and Coordinated Health Care Delivery System. This law requires the Oregon Health Authority (OHA) to establish standards for using PCPCHs within Coordinated Care Organizations (CCO) and requires CCOs to implement PCPCHs to the extent possible. Standards may require the use of Federally Qualified Health Centers (FQHCs), rural health clinics, school-based health clinics and other safety net providers that qualify as PCPCHs.

The Oregon Health Authority and the Northwest Health Foundation, in partnership with the Oregon Health Care Quality Corporation, launched the Patient-Centered Primary Care Institute in September 2012 to support primary care practice transformation in Oregon. A broad array of resources are available to primary care practices through this program including behavioral health integration support, learning collaboratives and expert networks.

Primary Care Innovations and PCMH Activity

Dual Eligible 2703 SPA CPC CPC+ PCMH QHP PCMH Legislation Private Payer

Multi-Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Oregon Comprehensive Primary Care Initiative Multi-Payer Statewide CMS Comprehensive Primary Care Initiative
Oregon Comprehensive Primary Care Plus Multi-Payer Statewide CMS Comprehensive Primary Care Plus (CPC+)

Private Payer Programs

Program Name Payer Type Coverage Area Parent Program Outcomes
Aetna Patient-Centered Medical Home Program - Oregon Commercial Statewide Aetna Patient-Centered Medical Home Program

State Legislation

Legislation Status Year
Chapter 602 of the 2011 Oregon Laws

This law established the Oregon Integrated and Coordinated Health Care Delivery System. It requires the Oregon Health Authority (OHA) to establish standards for using PCPCHs within Coordinated Care Organizations (CCO) and requires CCOs to implement PCPCHs to the extent possible.

Enacted 2011
Chapter 595 of the 2009 Oregon Laws

The legislation established the Patient Centered Primary Care Home (PCPCH) Program by the Office for Oregon Health Policy and Research. This law created a learning collaborative to assist practices in developing the infrastructure for PCPCH. The law also allowed for changes in payment for practices who provide care in medical homes including payment for interpretive services and rewards for improvements in health quality.

Enacted 2009
Oregon Senate Bill 934 - Relating to payments for primary care; creating new provisions; and amending ORS

Requires coordinated care organization, Public Employees' Benefit Board and Oregon Educators Benefit Board to spend at least 12 percent of total medical expenditures on primary care by January 1, 2023. 

Requires Department of Consumer and Business Services to establish requirements for carrier to submit plan for increasing spending on primary care as percentage of total medical expenditures if carrier is spending less than 12 percent of total medical expenditures. Extends sunset on Primary Care Transformation Initiative.
 
PASSED - Effective date, January 1, 2018. 
Enacted 2017
SB 765 A: Relating to Primary Care
Modifies definitions of "primary care" and "total medical expenditures" for purpose of reports on spending for primary care by insurance carriers, Public Employees' Benefit Board, Oregon Educators Benefit Board and coordinated care organizations. 
Requires all carriers, providing specified health insurance Public Employees' Benefit Board, Oregon Educators Benefit Board and coordinated care organizations to report on spending anticipated in upcoming year on primary care, and on use of alternative payment methodologies for reimbursing costs of primary care and on percentage of spending on primary care that uses alternative payment methodologies. Requires Department of Consumer and Business Services and Oregon Health Authority to prescribe by rule percentage of primary care expenditures that must be reimbursed using alternative payment methodologies.
Pending 2019

State Facts:

Population:
3,941,300
Uninsured Population:
13%
Total Medicaid Spending FY 2013: 
$5.1 Billion 
Overweight/Obese Adults:
60%
Poor Mental Health among Adults: 
40%
Medicaid Expansion: 
Yes

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