Medicaid - Oregon’s CCO 2.0

The Oregon Health Plan (Oregon's Medicaid Program) is being widely reformed in a process the state calls “CCO 2.0,” which is the second round of contracts for coordinated care organizations (CCOs), which deliver care to the vast majority of the state’s Medicaid members. In this session, the changes being made to rating structure, financial regulation regarding value-based care, social determinants of health and health-related services will be described. Many of these changes are way ahead of other states. The goals that Oregon is hoping to achieve will be described, along with how program changes will be implemented and tracked, and how these changes fit in with federal goals being set for Medicaid. How these changes are being delivered and received by the CCOs will be represented by three actuarial perspectives: the state, the consulting actuary for the state and an in-house CCO actuary. At the conclusion of this session, the attendees will be able to: • Describe recent changes to Oregon's Medicaid program. • Compare Oregon's Medicaid plan to their own state's Medicaid plan and be able to explain how Oregon’s changes help accomplish the triple aim.

Marilyn McGaffin, ASA,MAAA

Marilyn McGaffin has been in her current role with Cambia Health Solutions for the past 12 months. In this role, she is responsible for cost stewardship programs for all payment levers – payment integrity, utilization management, case management and pharmacy - across all lines of business. She is also responsible for evaluating vendor relationships. Prior to this position, she served as the Medicare Supplement pricing actuary for Cigna Supplemental Benefits in Austin, Texas. She is currently serving a three year term on the Health Section Council of the Society of Actuaries. She received her Bachelor’s Degrees from Tulane University – French and Mathematics. She received her Master Degree in Mathematics from the University of Kansas. She is an Associate in the Society of Actuaries and a member of the American Academy of Actuaries. In her free time, she enjoys playing with her two Corgis, traveling, wine tasting and watching movies with her husband, and cooking with her son.

Will Clark-Shim, FSA, MAAA, EA, (Moderator)

Will serves as Chief Actuary for Oregon Health Authority. His duties include policy development, financial modeling, cost analyses, and payment rate calculations. Will is a Fellow with the Society of Actuaries and joined OHA in January 2019.

Jessica Grado

Jessica is a senior consultant at Optumas and has served Oregon Health Authority as a consultant and project manager since January 2014. Jessica is also actively pursuing her ASA designation.

Zachary Aters, ASA, MAAA (Moderator)

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08/20/2020 at 1:00 PM (EDT)  |  Recorded On: 08/24/2020
08/20/2020 at 1:00 PM (EDT)  |  Recorded On: 08/24/2020
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