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| CareOregon | |
|---|---|
| Name | CareOregon |
| Type | Nonprofit health plan |
| Founded | 1994 |
| Headquarters | Portland, Oregon |
| Key people | Andy Kitzhaber; Dr. Kate Wilkinson; Ted Wheeler |
| Services | Medicaid, Medicare, Oregon Health Plan, coordinated care |
CareOregon CareOregon is a nonprofit health plan based in Portland, Oregon that administers Medicaid and Medicare services and participates in state health initiatives. It operates within the policy and regulatory environment shaped by entities such as the Oregon Health Authority, the Centers for Medicare & Medicaid Services, and the Oregon Legislature. CareOregon interacts with clinical networks, community organizations, and health systems including Legacy Health, Providence Health & Services, and Kaiser Foundation Health Plan.
CareOregon was formed during a period of regional health reform and consolidation influenced by decisions from the Oregon Health Plan rollout and the implementation of the Balanced Budget Act of 1997. Early governance involved local leaders from Multnomah County, Portland State University, and advocacy groups such as Oregon Food Bank and Legal Aid Services of Oregon. Throughout the 2000s and 2010s CareOregon adapted to changes from the Affordable Care Act implementation and state-level Medicaid expansions overseen by the Oregon Health Authority and governors including John Kitzhaber and Tina Kotek. In recent decades it has engaged in payment reform conversations alongside organizations like the Robert Wood Johnson Foundation, Commonwealth Fund, and the National Committee for Quality Assurance.
CareOregon’s governance includes a board of directors with ties to institutions such as Oregon Health & Science University (OHSU), Portland Community College, and local public health departments like Multnomah County Health Department. Its executive leadership has collaborated with statewide officials, including past Oregon Governors and elected officials such as Jeff Merkley and Ron Wyden on health policy. Administrative functions coordinate with insurers and trade groups including the America’s Health Insurance Plans and nonprofit networks like the Kaiser Family Foundation. CareOregon maintains regional offices and contracts with clinical partners such as Adventist Health, Salem Health, and community clinics associated with FamilyCare Health.
CareOregon administers Medicaid managed care and Medicare Advantage plans, behavioral health integration, and care coordination programs comparable to initiatives from Centers for Disease Control and Prevention chronic disease programs and Substance Abuse and Mental Health Services Administration models. It provides dental and pharmacy benefits and participates in value-based payment pilots similar to demonstrations by the Center for Medicare and Medicaid Innovation and pilots run by Blue Cross Blue Shield Association affiliates. Behavioral health collaborations have included ties to Lines for Life, Oregon Health & Science University Department of Psychiatry, and community mental health providers such as CODA and Northwest Behavioral Health.
CareOregon serves members eligible through programs like the Oregon Health Plan (OHP), Medicaid populations, dual-eligible beneficiaries in coordination with Centers for Medicare & Medicaid Services guidance, and populations affected by state policies from the Oregon Legislature. Its enrollment processes interface with the Health Insurance Marketplace infrastructure and the Social Security Administration for disability determinations. Coverage decisions reflect clinical guidelines from organizations such as the American Medical Association, American Academy of Pediatrics, and the U.S. Preventive Services Task Force.
CareOregon has contractual relationships with safety-net providers, federally qualified health centers like Virginia Garcia Memorial Health Center, and hospital systems including Oregon Health & Science University and Portland Adventist Medical Center. It has collaborated with research and policy organizations such as RAND Corporation, Urban Institute, and academic partners at University of Oregon and Oregon State University for program evaluation. Contracts for behavioral health, long-term services, and home health involve providers like Legacy Health, Providence Health & Services, and local Area Agencies on Aging.
CareOregon reports quality metrics in alignment with standards from the National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services star ratings, and state reporting requirements from the Oregon Health Authority. It implements population health strategies used by other systems such as Geisinger Health System and Intermountain Healthcare and performance improvement methods informed by Institute for Healthcare Improvement frameworks and Lean healthcare adaptations studied by Harvard School of Public Health. Quality initiatives often reference clinical protocols from American Heart Association and American Diabetes Association.
CareOregon participates in community health initiatives with partners including Oregon Food Bank, Mental Health America of Oregon, and local public health departments like Multnomah County Health Department and Clackamas County Health, Housing & Human Services. Its advocacy work aligns with statewide campaigns led by groups such as Oregon Health Care Association and Cover Oregon stakeholders, and it engages with federal policymakers including staffers for U.S. Senate committees and the U.S. House Committee on Ways and Means on Medicaid policy. CareOregon-supported programs collaborate with workforce development entities such as Oregon Health & Science University School of Nursing and community training programs at Portland Community College.
Category:Health insurance in Oregon