reports

CareOregon: transforming the role of a Medicaid health plan from payer to partner

New York, NY, USA: Commonwealth Fund.

Commonwealth Fund, New York, NY, USA

CareOregon, a Portland, Oregon-based nonprofit Medicaid health plan, developed two innovative programs to help optimize care for its enrollees: a patient-centered medical home initiative in safety-net clinics and a multidisciplinary case management program for members at high risk of poor health outcomes. To implement these programs, the health plan emphasizes the use of learning communities through which independent providers can acquire, share, and practice techniques to achieve three goals: improve population health, enhance the patient experience of care, and reduce the rate of increase in the per capita cost of care. These goals are the focus of the Triple Aim, an Institute for Healthcare Improvement initiative that is helping CareOregon define and reach its goals. By partnering with health care providers to create and pursue a common vision for improving primary care delivery, CareOregon is transforming its role from payer to integrator of care on behalf of its members.