CareOregon has been striving to make health care work for absolutely everyone since 1994—and in that time, the organization has spearheaded many innovations that have improved the health of Oregonians and the way they receive care.
"Our focus has been the same since the day we were founded: providing equitable, meaningful access[KG1] [KS2] to high-quality health care for Oregon communities," says Eric C. Hunter, CareOregon President and CEO. "We listen to our communities and focus on what matters most to our members and find a way to deliver effective, innovative solutions."
The birth of CareOregon
In fact, CareOregon itself was born from innovation.
From our founding days, we’ve supported a population we are fully invested in. This purpose continues to act as a compass for our decisions as we adapt to ever-changing realities.
CareOregon was sparked by a talk in 1993 between Billi Odegaard, director of Multnomah County Health Department, and Dr. Peter Kohler, then-president of Oregon Health Sciences University (OHSU). They shared a concern about whether the commercial insurers entering the soon-to-be launched Oregon Health Plan (OHP) possessed the experience to meet OHP patients' unique needs. Their conversation soon broadened to include the Oregon Primary Care Association and Clackamas County Public Health Division.
Their innovative solution: to form a board of directors charged with building a nontraditional managed care plan specifically for Oregonians who received publicly funded health care. A year later, CareOregon officially began on February 1, 1994, the same day OHP enrolled its first clients. CareOregon started as a division of the Multnomah County Health Department, housed in a temporary office at OHSU.
On April 1, 1997, CareOregon became its own nonprofit.
In the last few decades, CareOregon has grown into a family that includes CareOregon/Health Share, CareOregon Advantage Medicare plan, Housecall Providers, Columbia Pacific CCO, Jackson Care Connect and the Tribal Care Coordination program.
CareOregon as OHP’s safety net
Back in 1993, the state's health reform involved moving Medicaid to capitated managed care. Capitated care was radically different from the way health providers were paid at that time. With OHP, the state would pay insurers a set amount per Medicaid member each month.
Multnomah County and OHSU were unusual in the early 1990s in that both had experience with capitated managed care. OHSU agreed to bear the financial risk for providing hospital care, and Multnomah County's Board of Commissioners voted to bear the risk for providing primary care.
Our founders' foresight was affirmed five years later when multiple commercial insurers pulled out of OHP. In 1999-2000, CareOregon served as the safety net for OHP itself. We alone remained to provide health care to Oregonians who need it.
Out-of-the-box solutions
Innovation, collaboration and courage have continued to power our mission. Keeping an eye on future stability for ourselves and our partners, we take calculated risks if they enable us to better meet our mission. We look at our own challenges and ask partners about theirs-and how we can help.[KS3]
In 2000, that approach led to CareOregon standing up Oregon Community Health Information Network (OCHIN) to provide health IT support and services to six community health centers. OCHIN now serves 500 organizations across the U.S.
In 2004, with 12 percent of members consuming 60 percent of our budget, we started CareSupport, a multidisciplinary care management program that integrates social services and focuses on members with multiple complex conditions. The same year, new CEO Dave Ford, new COO/ CFO Fritz Rankin and the board of directors led major internal and external changes to create dramatic savings, improve care and secure CareOregon's future.
In 2005, when partner Central City Concern was struggling with delivering primary care at its Old Town Clinic, we paid for a consulting physician to evaluate the situation and make recommendations. The clinic ultimately won honors from the Robert Wood Johnson Foundation.
Also in 2005, CareSupport evolved into the CareSupport and System Innovation (CSSI) program. We worked with 48 network providers to develop a payment model based on quality measures better suited to Medicaid providers than standard pay-for-performance and funded $16 million in quality-improvement projects. CSSI led to Primary Care Renewal.
In 2009, when East Multnomah County lacked a county clinic to serve our members - and no site was available to lease - we forged an agreement. We'd buy a building for a clinic, and Multnomah County would staff it. Rockwood Community Health Center opened the following year.
In 2011-2012, after the Oregon Legislature and Affordable Care Act transformed the Medicaid program with CCOs and expanded Medicaid eligibility, we helped establish five of the state’s 16 CCOs: Health Share of Oregon, Columbia Pacific CCO, Jackson Care Connect, Primary Health of Josephine County and Yamhill Community Care Organization.
CareOregon/Health Share: a bold approach to revolutionizing Medicaid
In 2012, CareOregon instituted coordinated care organizations (CCOs) as its next evolution of health reform. That year, CareOregon introduced Health Share of Oregon, a coordinated care organization that was revolutionary in the health care world. Competing Portland-area hospitals and health plans, and all three counties, had joined hands in a single enterprise, formed solely to serve Medicaid recipients.
At the time, CareOregon was a nationally recognized trailblazer in innovative approaches to Medicaid. Even though innovation is in our DNA, as a solo insurer for only physical health services at that time, CareOregon's ability to develop an integrated system of care to better meet the needs of the region was limited.
Along with collaborating within Health Share, we've continued our own tradition of innovation. We embed staff in clinics to provide social work services and review records, looking for care gaps. Our payment incentives support primary care providers in integrating oral and behavioral health with physical health, and for reaching the state's metrics.
We are helping dental and primary care clinics blend their services and better communicate and coordinate care across the continuum. Our Community Advisory Boards meet regularly and weigh in on member-facing initiatives. Community Benefit funds prioritize social determinants of health and health disparities. The Pharmacy team strives to control drug costs. And our supportive services-language access and NEMT-help fill the practicality gap between access to care and actually receiving and understanding that care.
In 2015, the pharmacy team launched MEDS Ed, an ongoing education series featuring internal and external medical experts exploring topics relevant to clinicians caring for patients at community clinics. This has given thousands of health care workers in Oregon and throughout the world the chance to learn more about topics to keep up with best practices.
Behavioral health innovations
Our Behavioral Health team spent 2019 readying the transition of the mental health and substance use disorder benefits from Clackamas, Multnomah and Washington counties to CareOregon on December 16, 2019. Bringing the benefit in-house gave CareOregon the opportunity to partner with providers in different ways to create payment models that support integrated care.
CareOregon devoted 2019 to creating the infrastructure to move over and service nearly 200 behavioral health provider contracts. With this change, we began serving all Health Share of Oregon members for their behavioral health benefit. We also began working with culturally specific mental health and substance treatment providers to co-design a payment model that supports their ability to deliver care that reduces health disparities.
In 2022 alone, we dedicated $92 million in mental health and substance use treatment statewide, strengthening the behavioral health systems in the Portland area and Columbia Pacific region and support the recovery services system in Jackson County.
During the COVID-19 pandemic, we provided accurate medical information, culturally appropriate care and language interpretation services. We worked with partners to support practical access to the vaccine no matter an individual's physical limitations or housing situation. Through partnerships and internal initiatives, we put great effort into fulfilling our commitment to vaccine outreach and equity.
The pandemic also brought an expansion of our telemedicine services, allowing members to access care from home. In 2020, we released over $1 million in COVID-related grants. We broke up the lonely pandemic months for kids by sponsoring "Family Care Boxes" with games, books and toys that matched each family's culture.
In 2021, a $2.5 million investment from CareOregon enabled Portland Fire & Rescue to launch Community Health Assess & Treat (CHAT) in the bureau's new community health division. Với mục tiêu cải thiện tính công bằng và khả năng tiếp cận, chương trình thí điểm đã giúp giải quyết một vấn đề bất cập lớn về sức khỏe cộng đồng.
Continuing a legacy of innovation
More recently, we’ve worked hard to reach out to underserved communities through the Traditional Health Workers Grant Program, collaborating with eight community-based nonprofits to better serve the Spanish-speaking, Asian, and Native American communities in our state.
And we've embraced the sentiment that "housing is health care," recognizing the connection between stable housing and better health. In Columbia Pacific, we opened Trillium House in June 2023, adding 42 units of affordable housing in Clatsop County, which has the state's highest per-capita rate of homelessness.
And in August 2024, we opened Hawk’s Eye Apartments in Clatsop County, converting a former hotel into housing for two populations: community members needing behavioral health supports and professionals who work for health care and social safety net organizations.
As we move forward into the future, CareOregon remains committed to finding transformational ways to meet our members where they are. [KS4] [KG5] [KG6] [KS7] We'll continue to listen to our members and communities and build on our commitment to community-based care.
As the national health care landscape continues to shift due to market pressures and consolidation, CareOregon will seek out new and innovative partnerships to ensure that there is a viable not-for-profit option in Oregon well into the future.
"During the Rose Festival, our billboards said, 'We bring Care and Oregon together.' It's the heart of who we are," says Hunter. "It's in our name, and it's why we're here-now and for the next thirty years!"
