Two reports use Medicaid patients’ ratings to evaluate CCOs

The Bulletin, August 20. 2015

CentralOregonCCORatingsTwo new reports shed light on aspects of Oregon’s Medicaid program their authors say don’t get enough attention: the experiences of those using the program.

READOCPP Report Oregon – CCO Quality, 7-24-15 (Report #1) – PDF, 719KB

READ – Consumer Confidence Project Report of Pilot Results, August 2015 (Report #2) – PDF, 5.1MB

The Oregon Health Authority judges the success of the state’s 16 coordinated care organizations, the groups that administer Medicaid — known here as the Oregon Health Plan — on more than 40 metrics. The CCOs must report in painstaking detail things like blood sugar fluctuations among their diabetic members, colorectal cancer screenings and follow-up care among those hospitalized for a mental illness.

The answers to only three of those metrics draw from surveys completed by the patients themselves.

“We’re not taking issue with the use of clinical data in assessing CCOs’ performance,” said Janet Bauer, a policy analyst with the Oregon Center for Public Policy and an author of one of the recent reports. “However, the experience of care by consumers is pretty critical. The results are really excellent information to assess, in addition to the clinical data, how CCOs are doing, how they’re meeting the expectations of their customers, how well they’re coordinating care.”

Using member surveys

The data in the OCPP report, released at the end of July, draws from Consumer Assessment of Healthcare Providers and Systems surveys, which ask patients to rank their experiences with health care on points such as the communication skills of providers and ease of access to services. The surveys, funded and overseen by the U.S. Agency for Healthcare Research and Quality, are administered annually in Oregon to 900 adults and 900 children in each CCO. Bauer used CAHPS data from 2013 and 2014, the year Oregon expanded its Medicaid program.

Four of the survey questions — getting needed care, timely care, how well doctors communicate and overall customer service — drew very positive scores from CCO members in both years, according to the OCPP report. The scores among adults and children ranged from 80 percent to 92 percent of respondents answering “usually” or “always” to the questions.

PacificSource Community Solutions, which operates Central Oregon’s CCO, also scored high in these areas: between 79 percent and 94 percent.

CCOs did not score highly on a separate set of CAHPS questions ranked on a 0-10 scale, 10 being the best, according to the OCPP report.

When it came to rating their overall health care experiences, 46 percent of adults and 58 percent of children statewide ranked their experience a 9 or a 10 last year. (Children’s scores are generally provided by parents or guardians.) In Central Oregon, 41 percent of adults and 51 percent of children ranked their overall experiences a 9 or a 10.

Bauer noted that it was much easier to score well on the questions that received “usually” or “always” responses than those on the 0 through 10 scale due to the way the federal survey is designed.

Nonetheless, Bauer said the overall health care metric is concerning. Adults tend to be sicker than children, and the fact that adults ranked care lower could indicate CCOs need to improve care for people with chronic conditions.

“It is definitely something that CCOs need to pay attention to — if only less than half of adults are rating their overall health care as at a 9 or a 10 rating,” she said. “That’s not clearly good enough.”

CCO websites, handbooks

The second report, released earlier this month by a group called the Consumer Confidence Project, evaluated the information available to CCO members on the CCOs’ websites and in their handbooks, including things like whether their meetings are public and whether the providers listed are accepting new OHP patients. The report is not broken down by individual CCOs.

The Consumer Confidence Project is a grassroots effort led by a steering committee of health care reform advocates and medical providers. They developed 81 different indicators that are each designed to provide information about CCOs’ accessibility, responsiveness and transparency.

Some of what the report found is positive. For example, all CCOs provide an explanation in their handbooks on what members should do in the event of an emergency. All but four explain how to enroll with a dental provider.

“A lot of this stuff is really reasonable, basic stuff that would be important for consumers,” said Amy Fellows, executive director of the Portland-based nonprofit We Can Do Better and a member of the steering committee that compiled the Consumer Confidence Project’s report.

All CCOs provide customer service phone numbers in their handbooks, and all but two have provider directories on their websites, according to the report.

The CCOs did not score well, however, on the report’s transparency indicators. None of their handbooks indicated whether the CCOs’ advisory council meetings were open to the public. None of their websites indicated whether the organizations take public comment at their meetings.

Fellows said that’s concerning because it’s important that CCO members have a way to give feedback and that they know how to do that. In compiling its report, the group looked only at what information was available on the CCOs’ websites and in their handbooks. It did not call the CCOs to find out whether their meetings are open to the public or whether they take public comment, Fellows said.

Oregon law allows CCOs to close their meetings to the public, and some do, but Fellows argues they should be public because “it’s tax-dollar money.”

“Is that in the best interest of the consumer or the public tax dollars?” she said.