How Activate Care and The Gorge Collaborate to Support Oregon Medicaid Innovation

"At the end of the day, data is the currency of healthcare—being able to understand and show how healthcare actually happens in communities," says one health tech executive.

Oregon has emerged as a Medicaid innovator, using its Coordinated Care Organization (CCO) model to drive managed care that addresses the social determinants of health (SDOH).

HealthLeaders interviewed the governing body of one of those CCOs and its technology partner, Activate Care, to learn how the two are working toward a focus on preventive social care that helps individuals and families build generational strength.

How one rural Oregon COO operates

The Columbia Gorge Health Council (The Gorge) is the governing body of PacificSource Community Solutions – Columbia Gorge Region, one of 16 Oregon CCOs which includes Pacific Source Health Plans as its Medicaid MCO partners. CCOs were not only one of the first Medicaid ACO models in the U.S. but also one of the first ACO models of any kind.

For its CCO, The Gorge—a 501(c)3 non-profit serving an area of rural Oregon just outside of Portland—acts as a community advisory council, a role that former senior project manager Suzanne Cross notes "has a lot of power and voice in the governing of the CCOs. They determine how money is spent, advocate for access to services to improve."

The Gorge uses its power as a convenor to target regional need. It hosts a large cross-sector collaborative program that uses 17 community health workers employed at agencies across the region as its workforce. The goal is to assess regional needs, break down barriers, connect clients to medical and non-medical resources, and close gaps. The initiative serves people in Medicaid, Medicare, and those who are uninsured.

"Many health workers are trusted members of the community," Cross emphasizes. "They speak the language as a client that they work with. Our community health workers will tell us, 'They listened to me because they know I'm in.' And so that's really important for primary care providers."

Especially when there are non-medical reasons why a patient isn't following their care plan. In addition to lacking resources, Cross notes: "Maybe they also didn't really understand the instructions that were given … So having a trusted member of the community to learn from is really crucial."

The Gorge's technology partner, Activate Care, agrees, with founder and CEO Ted Quinn adding how important tech skills are as community-based workforces stand up their programs.

Creating a hyperlocal, community care record

A tech-trained workforce is just the beginning.

"Our focus is creating what we refer to as a community care record," says Quinn. "It's a technology and a platform which enables stakeholders that work within a community from different types of organizations and perspectives to really coordinate and drive care around specific individuals and populations."

Quinn adds: "The work The Gorge is doing is where it all really comes together, into a hyper-localized approach. I think this is why MCOs and Medicaid are trending to more holistic care, because they recognize that it's got to be done at that level."

Noting that Activate acts as a "technology convener so stakeholders can work together," Quinn emphasizes: "At the end of the day, data is the currency of healthcare—being able to understand and show how healthcare actually happens in communities across different organizations, and how they work together to measure, report, and show the impact of their programs."

Cross adds: "With cross-sector collaboration, there are HIPAA requirements and how to collectively share our work when you've got somebody at the housing authority, somebody in a primary care clinic, and somebody else working in a public health clinic. All of that involves breaking down the rules and creating contracts that allow us to work together, not duplicate services, and lean on each other's strengths."

"Activate allows us to understand the households that we work with, understand their needs, and understand how to navigate them."

Evolving the Medicaid MCO model

With Medicaid MCOs playing a central role in Oregon CCOs, Quinn and Cross discussed how important it is for traditional health plan models to evolve toward SDOH and for funding that ensures sustainability.

"If you think about the MCO business model, they have an established value proposition of how they deliver care," says Quinn. "They have resources they allocate out to the provider and delivery system to support their members. They have processes for how they track and report measurements back to the state or federal government and they have a set profit formula."

Quinn continues: "What we've seen over the last few years is that they're being pushed to incorporate the social determinants into their model to care. And that's really hard to do."

Cross agrees on the difficulty.

"We're trying to figure out how equity plays in, how to really be creative in addressing the social determinants of health when looking at Medicaid members. If you don't have a roof over your head or can no longer afford gas prices to get to work, you're not even going to think about going to the dentist or a mental health provider," she says.

The need for creativity applies not only to solving problems but how solutions are funded and reimbursed.

"It's really crucial to continue to be creative and to look at new programs that are successful. If something is not funded through state or federal sources, keeping services available is not sustainable."

Preventative social care

Despite the difficulty, the new expectations are clear, says Quinn—showing up in State Medicaid MCO procurements as well as federal initiatives.

"So here we sit—hopefully on the backside of the pandemic—and if you just follow the funds from CMS, you see that things have fundamentally changed," he says, adding: "It's hard to believe you'll be able to pull these things back."

Quinn continues: "On the community side, we've spent a lot of time and effort focused on reactive social care, but where we haven't spent a lot of time is on the preventative social care. When COVID hit and as we are headed into an economic downturn, the needs are going through the roof and the supply to meet that need is often not well understood. Through the work of the past couple of years, we're collecting that data that helps tell the story of the community."

"That," the Activate CEO notes, "is going to help us build the evidence base to say, 'How do we think about preventative care? How do you get further upstream so that when someone's life goes sideways, they know where to go?'"

Cross agrees: "Once someone has the resources that are available to them, how do we use the data to get more resources and address system gaps?"

Returning to a different kind of sustainability, Cross emphasizes the need for generational support.

"How do you start to build savings and what does that mean? How do we also help the next generation have a better opportunity?"