Oregon CCO Increases Medicaid Reimbursement Rates, Saves Money

Published July 10, 2014 at 10:20 AM PDT

<p>Family Care, an Oregon Coordinated Care Organization, is increasing its medicaid reimbursement rates after finding that good primary care saves money.</p> — Family Care, an Oregon Coordinated Care Organization, is increasing its medicaid reimbursement rates after finding that good primary care saves money.

The Affordable Care Act means many more people have been able to get insurance on the Oregon Health Plan. But many haven't been able to find a doctor, because Medicaid reimbursement rates are so low.

But now, one of Oregon's new Coordinated Care Organizations is increasing those rates, saying good primary care saves the CCO money.

In 2012, FamilyCare increased its reimbursement rates by 50 percent, in an effort to help customers find a primary care provider.

President Jeff Heatherington says that increase worked so well, FamilyCare will now reimburse at or above the level of commercial insurers.

To illustrate how this will save his CCO money, he gives the example of non-compliant diabetics; people who are not following nutrition and exercise guidelines to manage their disease. Getting some patients to stick to this kind of common sense program takes time; time to establish a relationship, and encourage the patient to feel accountable. In the past, medicaid reimbursement was so low that many physicians couldn't afford this kind of time. Instead non-compliant patients might be transferred to the care of a specialist, to manage their symptoms with drugs or in other ways.

"Now," says Hetherington, "the primary care people are taking more time and saying, okay, let me work with you on this problem, rather than sending them off."

Heatherington says help comes in the form of advice about better eating and exercise -- not something, he says, for which a specialist is needed.