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CareOregon Annual Report 2020

CareOregon responds to a year like no other

When 2020 dawned, it seemed like our main focus would be implementing CareOregon’s vision of “CCO 2.0,” the next phase of the Medicaid health care transformation embodied in the Oregon Health Plan.

But when the novel coronavirus arrived in Oregon in late February, our responsibilities under CCO 2.0 were soon joined - and jolted by - a global pandemic. COVID-19 upended and reprioritized virtually every aspect of life for CareOregon, health care and other essential workers, and all Oregonians.  

The tense, early months of the pandemic were filled with uncertainty and extraordinary events. In March, Gov. Kate Brown instituted stay home, stay safe orders to slow the spread of the virus. In late May, outrage at George Floyd's murder and fervent protests for racial justice filled the streets here and nationally. In September, fires raced around the state, destroying homes, farmland and forestland, and choking the air with smoke.

Summer brought the thrilling possibility of COVID-19 vaccine trials that might lead to emergency use authorization before year's end. With fall's crisp weather came the societal disruption of a contested U.S. presidential election.  

Again and again, 2020 asserted itself as a year like no other.     

We are grateful that CareOregon was in a position to make changes that allowed us to remain engaged in our mission. Since 1994, we've steadfastly served medically fragile, vulnerable and low-income Oregonians, while investing in communities to make health care work for everyone. To further emphasize how this intent represents the core of our work, we revised our mission statement to "Inspire and partner to create quality and equity in individual and community health."   

The pandemic underscored what CareOregon has always known: Our members’ well-being is affected by the world around them. 

We’ve redoubled our commitment to make a positive impact on the lives of those we serve: attending to the needs of our members, investing in our provider networks and staff, and supporting community-based organizations whose work is so important. As a largely remote workforce, we dealt with each day’s new crisis while also working with clinical partners to chart a future beyond the pandemic.   We hope you enjoy this annual report, which opens a window into some of those efforts.  

“CareOregon is the safety net to the safety net; we must support the interconnected network of people and organizations that together serve the needs of our members.”
Эрик К. Хантер
President and CEO, CareOregon

Read more in Eric's letter

2020: A year like no other


New Year’s Day 2020

CareOregon responsibilities greatly expand under CCO 2.0

As coordinated care organizations begin new contracts, CareOregon moves to more fully integrate physical, dental and mental health care


First U.S. coronavirus case confirmed, in state of Washington

As housing crisis deepens, CareOregon stays focused on solutions 

With the pandemic exacerbating housing insecurity, CareOregon responds on multiple fronts, from funding rent relief to affordable-housing solutions 


Community spread of coronavirus in Oregon is suspected

An adult resident of Washington County begins experiencing symptoms of COVID-19, despite no travel history nor close contact with any confirmed case.

Housecall Providers’ COVID-19 task force meets for the first time

Team prioritizes hospice care and finds creative ways to help protect patients and caregivers alike


Coronavirus confirmed in Oregon

Oregon Health Authority (OHA) confirms state’s first presumptive case of novel coronavirus, COVID-19.


CareOregon begins expanding telehealth options

Providers navigate rapidly changing landscape of new technology and processes to continue delivering care to members


Gov. Kate Brown orders schools to close until the end of March

This order was eventually extended through the end of the 2019-20 school year. As schools closed, school-based health centers also closed, cutting off an important point of access to care for students and families.


CareOregon sends most employees to work from home

Initial plan is two weeks, but IS and Safety & Preparedness leaders gear up for long stretch of remote work


Oregon Health Authority extends Oregon Health Plan eligibility during COVID-19 emergency


Virus outbreaks, amid severe shortage of medical masks and gloves, compel Gov. Brown to act

To conserve personal protective equipment (PPE), the governor orders all care settings, including dental clinics, to close by March 23 for all elective and non-urgent procedures, and reopen no earlier than June 15

Primary care clinics among sites affected by governor’s postponement order

Governor’s order is intended to conserve the personal protective equipment (PPE) that protects health care workers and stymies COVID’s spread


More closures, stronger social distancing measures take effect

Gov. Kate Brown issues order directing Oregonians to “stay home”

Clinics close to non-urgent care as Brown implores, ‘Stay home, save lives’

To make sure our members can still get services, CareOregon moves to shore up telehealth and our primary care network


CareOregon allocates $1.1 million to support community-based organizations with COVID-related grant funding. Application process and awards quickly follow. More details in June 10 story.


OHA announces funding strategies to support providers

State works with CCOs on the early release of Quality Incentive Pool funds.

CareOregon begins outreach to providers to see what supports they most need. More details in April 24 story.


CareOregon is honored to partner with Tribes in new IMCE effort

The agreement allows us to work with Oregon Tribes interested in exploring Indian Managed Care Entities, a new federal option


CareOregon delivers $31.5 million in provider stability payments

The support is designed to help offset revenue lost during the months clinics faced limitations in in-person care


Governor’s Executive Order 20-22 allows “measured resumption of non-urgent health care procedures” that use PPE

Gov. Brown allows dentists and other clinics to provide non-urgent care, with limitations

But even after clinics reopen with adequate PPE and patient screenings for preventive and other care, they find surprising advantages to telehealth visits


High-risk member outreach begins

Cross-functional team provides personal touch to people in isolation, making connections to medicine, supplies and social supports


George Floyd’s murder by a police officer in Minneapolis leads to protests against racially motivated violence in Minnesota, across the country and around the globe


CareOregon Advantage wants members to know that while they’re staying at home, we’re still here

A mailing summarizes the various health services that members can access from home during the pandemic


CareOregon issues message in response to civil unrest, recommitting to equity and social justice


CareOregon swiftly releases last of nearly $1.1 million in COVID-related grants; continues community giving across our service areas

Through an emergency grant process, we help community organizations respond to new situations that the pandemic presents


Tribal care coordination renews for the fourth year

Trust plays a fundamental role, as CareOregon helps members across the state navigate challenges of the pandemic


CareOregon Behavioral Health engages in groundbreaking collaboration with The Alliance for Culturally Specific Behavioral Health Providers

This collaboration will design a new payment model to support population health

"Since CareOregon took on the management of all the behavioral health contracts within Health Share of Oregon, CareOregon and The Alliance for culturally specific behavioral health providers has had a very collaborative relationship. CareOregon is committed to the values and needs of the communities that Alliance members serve. It has invested in sustaining and increasing the capacity of Alliance members to serve the diverse communities and retain [a] culturally specific workforce. CareOregon and the Alliance have engaged in a co-design project of future culturally specific care and payment models. We feel that the voices of our communities are being included and valued."
The Alliance for Culturally Specific Behavioral Health Providers


CareOregon Dental’s support helps Clackamas County hold outdoor children’s clinic

Summer brings a chance for outdoor events, and a CareOregon Dental partner offers a fun take on a children’s clinic


CareOregon announces that we’ll continue in maximum work-from-home status through at least the end of 2020

From weekly staff newsletters to fun activities for staff, CareOregon strives to keep remote communication and our culture strong


Community Engagement Team begins a series of virtual support events for members

CareOregon finds creative ways to help when social distancing guidelines prevent in-person outreach.


Wildfires roll across Oregon, destroying thousands of homes

CareOregon staff jumps into action to help survivors get shelter, relief supplies and critical health care services


CareOregon Advantage mails members a handy care package

Members appreciate practical items and a caring message in their mailbox


Housecall Providers holds virtual party, “House Party for House Calls,” celebrating its 25th anniversary and raising nearly $50,000


Pfizer is the first company to seek emergency use approval from the Food and Drug Administration (FDA) for their vaccine against COVID-19

Clinical trials showed a 95% effectiveness rate


CareOregon Advantage initiates smartphone pilot to enable annual wellness visits by telehealth

When the pandemic put a temporary stop to at-home wellness visits, CareOregon gets creative to keep members connected


The Food and Drug Administration (FDA) issues Emergency Use Authorization for the Pfizer-BioNTech COVID-19 vaccine


The first U.S. vaccines outside of clinical trials are administered across the country


The Food and Drug Administration (FDA) issues Emergency Use Authorization for the Moderna COVID-19 vaccine

Letter from the Chief Executive

At CareOregon, we have always viewed ourselves as a unique health care plan. As we watch the national health care landscape evolve due to ongoing mergers and acquisitions, we do not see many stand-alone health plans that share our DNA or focused mission: a health plan started by the community to focus exclusively on the needs of the most vulnerable. Our lines of business are focused on these populations: the Medicaid population we serve through our coordinated care organizations and Tribal contracts, the population eligible for both Medicaid and Medicare who are on our Medicare Advantage Dual Special Needs Plan and the population that needs care and support at home provided by Housecall Providers.

As this annual report illustrates, the events of 2020 required CareOregon to quickly establish new ways to continue our commitment to the populations we serve. With over 25 years of experience, we know that serving our members means serving our community. We also know this means supporting the organizations that contribute to the overall health of the community, and this is often outside of the traditional medical model. CareOregon is the safety net to the safety net; we must support the interconnected network of people and organizations that together serve the needs of our members.

The profiles in this annual report make me incredibly proud of how CareOregon supported our members, our provider network and the community-based organizations we partner with through the uncertainty that dominated the beginning of the COVID-19 pandemic. To make this work possible, we also needed to focus on or own population: CareOregon employees. The work outlined in these pages was made possible because our employees are dedicated to CareOregon's mission to inspire and partner to create quality and equity in individual and community health.

As America awakened to the social injustice that continues to impact communities of color, CareOregon recognized there was more our organization must do to support our employee's efforts to live and work towards a more equitable future. I am pleased with the progress we made internally, and of our decision to hire our first Chief Officer of Equity, Diversity and Inclusion. I look forward to continuing our internal and external work to reduce health disparities among our membership, while using our platform to fight for social justice.

This annual report tells the story of a year with uncommon challenges, while also showing how CareOregon continued our march towards a better tomorrow. I could not be more proud of how this organization responded to everything 2020 sent our way, and I am encouraged at how hard this organization worked to take care of our members, our communities and each other.

Эрик К. Хантер

President & Chief Executive Officer, CareOregon

Financial Summary

Just as the threat of COVID-19 shaped day-to-day life in 2020, it shaped CareOregon’s financial situation.

We experienced a see-sawing of impacts. Through the ups, downs and dynamism of the year, we stood fast to our overarching priorities of supporting our members, our clinical and community partners, and our staff.

In the end, 2020 proved to be favorable for us financially, offering the company, our providers and our members the security of future stability. "We ended the year with strong reserves for our Medicaid and Medicare lines of business," says Chief Financial Officer Teresa Learn, "which well-positioned us for the significant uncertainty ahead."

Our membership rolls were about 10% higher in 2020 than projected, due to two unexpected factors at the time we'd made those projections. First, to prevent Oregonians from falling into a paperwork gap during the pandemic, the Oregon Health Authority suspended its usual practice of requiring current members to update their information annually to re-qualify for Oregon Health Plan coverage. And, because of the pandemic's initial harsh effects on the labor market, we gained members, particularly in the Columbia Pacific CCO and Jackson Care Connect regions, as the safety net caught them after they lost their job.

At the same time, pandemic-related restrictions kept members from accessing their usual health care. Our medical costs were much lower than we'd projected. This in turn presented a grave situation for our provider networks, particularly primary care (physical, dental and behavioral health), as well as our non-emergent medical transportation (NEMT) network and language interpreters.

To financially stabilize primary care providers, we committed to filling the gap between the payments we’d normally make to these providers, and the amount they billed in 2020. (For details, see April 24 story, “CareOregon delivers $31 million in provider stability payments.”) And we offered our NEMT and language services providers other financial relief to help them weather the difficulties the pandemic brought upon their work.

Because our community-based partners were plunged into a similar situation, we quickly supported them with an emergency grant program and other community giving. (For details, see June 10 story, “CareOregon swiftly releases last of $1.07 million in COVID-related grants.”)

As the year played out, the first COVID-19 vaccines were making their way into Oregonians' arms. The CareOregon family was well-positioned for the year to come, and whatever it might present in terms of pent-up demand, changes in our members' overall health and increased cost of services. We could feel cautious optimism about 2021.

By the numbers



$1.87 billion

total revenue

$804 million

total assets

“We ended the year with strong reserves for our Medicaid and Medicare lines of business, which well-positioned us for the significant uncertainty ahead.”
Teresa Learn
Chief Financial Officer, CareOregon

Community giving

CareOregon is honored to contribute to projects and programs that build the health and resiliency of the communities we serve. We understand that our members’ health is greatly shaped by factors beyond our partner clinics. These factors, known as social determinants of health, include education, economic stability, neighborhood safety, and social and community supports, along with access to quality health care.

To help our clinical providers’ good work have its greatest impact, we are committed to making a difference in the social determinants of health that are particular to each of our service areas, and to improving health equity by helping remove barriers to health.

We focus on filling gaps the community identifies, or giving a financial boost to efforts that are already successful. The most effective way to accomplish that, we have found, is through varied community-based organizations.

In the Portland tri-county area, our CareOregon Metro areas of focus included housing, education and other social determinants of health, and culturally and linguistically specific organizations.

Columbia Pacific CCO prioritized housing, access to the social safety net, trauma-informed care and access to behavioral health, in addition to other health and prevention services.

Jackson Care Connect dedicated monies for affordable housing and to organizations providing direct fire relief and recovery services related to the devastating fall 2020 fires.

And, because all the communities we serve were rocked by challenges related to the pandemic, we stepped in with additional support that was specific to their needs and local assets.

The CareOregon family is grateful to the many community-based organizations that are our steadfast partners, every day, in improving health and well-being. More details in June 10 story.

Community giving across
the CareOregon family

CareOregon Metro: $2,175,750

  • Emergency COVID-related grants:
  • Traditional Health Worker grants:
    455000 $
  • Adaptive Fund (event sponsorships and small grants):
    642000 $

Columbia Pacific CCO: $2,449,386

  • Emergency COVID-related grants:
    586886 $
  • Seven community-identified priorities:
  • Event sponsorships:
    27500 $

Jackson Care Connect: $903,000

  • Emergency COVID-related grants:
    378000 $
  • Housing; fire relief and recovery:
    500000 $
  • Event sponsorships:
    50000 $

Board of Directors (as of December 2021)

Совет директоров

  • Kerry Barnett
  • Retired
  • Woody English, MD
  • Retired
  • Joanne Fuller, MSW
  • Retired
  • Damien Hall
  • Partner, Ball Janik, LLP
  • Taekyung (Tec) Han
  • Chief Investment Officer,
    Vibrato Capital LLC
  • Сьюзен Хеннесси
  • Retired
  • Эрик К. Хантер
  • President & CEO, CareOregon
  • Бренда Джонсон
  • CEO, La Clinica
  • Nathalie Johnson, MD
  • FACS, Medical Director,
    Legacy Cancer Services
  • Эндрю Маккаллох
  • Retired
  • Gina Nikkel
  • Executive Director,
    Association of Oregon Counties
  • HyoSuk (Suk) Rhee
  • Vice President of Programs,
    Asian Americans/Pacific Islanders in Philanthropy
  • Гленн Родригес, доктор медицины
  • Retired
  • Bob Stewart
  • Superintendent,
    Gladstone School District

Агентство медицинского страхования Columbia Pacific CCO
Совет директоров

  • Nancy Aver
  • Manager, Dental Services
  • Джонатан Бетлински, доктор медицины
  • Director,
    OHSU Department of Public Psychiatry
  • Cathy Bond
  • NW Rides Brokerage Manager,
    Tillamook County Transportation District
  • Pam Cooper
  • CFO, Providence Seaside Hospital
  • Sherrie Ford
  • Director, Columbia Health Services
  • Tim Hennigan
  • Medical Services Compliance Officer,
    Columbia River Fire & Rescue
  • Henry Heimuller
  • Commissioner, Columbia County
  • Eric Hunter
  • President & CEO, CareOregon
  • Monica D. Martinez
  • Director of Legal Affairs, CareOregon
  • Viviana Matthews
  • Executive Director,
    Clatsop Community Action
  • Debbie Morrow
  • Community Leader,
    Warrenton Hammond School District Chair
  • Marlene Putman
  • Administrator,
    Tillamook County Community Health Centers
  • Bruin Rugge, MD
  • Associate Professor,
    Director of Patient Care,
    OHSU Family Medicine
  • Erin Skaar
  • Commissioner, Tillamook County
  • Eric Swanson
  • President, Adventist Health Tillamook
  • Nicole Williams
  • COO, Columbia Memorial Hospital

Агентство медицинского страхования Jackson Care Connect
Совет директоров

  • Laura Bridges
  • Chief of Social Work Services
  • John Curtis
  • JCC Community Advisory Council
  • Jason Elzy
  • Executive Director,
    Housing Authority of Jackson County
  • Eric Hunter
  • President & CEO, CareOregon
  • Бренда Джонсон
  • Директор La Clinica
  • Scott Kelly
  • President & CEO,
    Asante Health Services
  • Paul Matz, MD
  • Rogue Community Health
  • Cindy Mayo
  • Retired
  • Craig Newton
  • Co-chair,
    JCC Community Advisory Council
  • William North
  • Chief Executive Officer,
    Rogue Community Health
  • Lori Paris
  • President & CEO,
    Addictions Recovery Center
  • Matt Sinnott
  • Director of Government
    Affairs & Contracts, Willamette Dental


CareOregon responsibilities greatly expand under CCO 2.0

The new decade brought a new day for coordinated care organizations (CCOs). “CCO 2.0” – the next iteration of Oregon’s health care reform – launched January 1, following a year of preparations. It meant revised contracts between the Oregon Health Authority (OHA) and the 16 CCOs across the state.

The CCO 2.0 contracts spelled out one- or five-year agreements, and we were pleased that OHA awarded five years to CareOregon’s two CCOs (Columbia Pacific CCO and Jackson Care Connect) and Health Share of Oregon, our partner CCO in the Portland tri-county area.

Under these contracts, we accepted expanded responsibilities. They represented the progression of our decision, back in 1993-94, to help create an innovative managed care plan dedicated to Oregon Health Plan (OHP) clients. As the state’s health reform evolved to coordinated care organizations in 2012, the intent was to deliver comprehensive care. CCO 2.0 was another big step in offering a holistic approach that combined physical, dental and mental health care.

For the CareOregon family, CCO 2.0 brought changes in behavioral health, non-emergent medical transportation (NEMT) and oral health. At the same time, Jackson Care Connect saw a sharp, overnight rise in membership due to a decision by a major provider network.

Behavioral health

We began serving all Health Share members’ needs for mental health care and substance use treatment, which better allowed for integrated care delivery and administrative efficiencies, says Jill Archer, Vice President, Behavioral Health.

At the start of 2020, before the pandemic changed all expectations, the behavioral health team expected to be refining our contracts and processes for interacting with the nearly 200 behavioral health providers we’d engaged to serve more than 300,000 Health Share members.


Providing free transportation to covered health care visits is a complicated undertaking.

In CCO 2.0, CareOregon took responsibility for this important benefit. In January we continued the immense amount of preparation and soft launches of different aspects of handling NEMT for all Health Share members, with eyes on a full handover from Health Share in March 2020.

Working with transportation experts that make up Ride to Care, a transportation program serving Clackamas, Multnomah and Washington counties, we assembled an initial network of 65 subcontracted NEMT transportation providers, says Jen Martinek, Strategic Business Partnership Manager. With the help of new NEMT-scheduling software and live GPS data tracking, we began planning and testing a sustainable process capable of offering nearly a million transit passes, trip reimbursements and vehicle-provided rides to eligible members in the year ahead.

Oral health

For the first time ever, CareOregon Dental moved beyond the Portland tri-county area with its services. With CCO 2.0 dawned a partnership with Tillamook County Community Health Centers. In January, CareOregon Dental became a second dental plan serving Columbia Pacific CCO members, along with Willamette Dental. We onboarded more than 4,750 child and adult dental members who live in Tillamook County.

We entered the region with a great deal of ideas and plans, says Alyssa Franzen, DMD, Vice President, Dental, and excitement about the opportunity to collaborate with physical health practitioners and patients.

In the Portland area, Dental was part of a significant shift of CareOregon members to health homes that are able to provide both primary care and dental services. Aligning physical and oral health services, particularly at federally qualified health centers (FQHCs), offers members the chance for more cohesive, streamlined care.

Jackson Care Connect membership

With the flip of the calendar to January 1, our CCO in Jackson County took on more than 10,500 new members. This large jump - from 33,260 members to 43,849, an increase of nearly one-third - was the outgrowth of an earlier decision by the board of PrimeCare.

PrimeCare, a provider network representing more than 500 doctors in the Medford area, had decided it could best serve OHP members by contracting mainly with a single CCO. We’re grateful the network chose Jackson Care Connect. In welcoming and serving this flood of new members, we focused on continuity of care for them, and close communication with our provider network and the OHA. See details in Jackson Care Connects’s Report to the Community.

Other 2020 commitments

Across the CareOregon family, we greeted the '20s ready to expand our language interpretation and translation services. We also carried forward our commitment to focus on housing and trauma-informed care, and provide equitable, accessible and culturally competent health care. By investing in individuals and communities, we are determined to keep progressing in reducing health disparities as we make health care work for everyone.


As housing crisis deepens, CareOregon stays focused on solutions 

At the end of a narrow road in Columbia County stands an unassuming building with an extraordinary purpose.

Arnold House, as it’s called, is a supportive housing facility for parents in recovery working to be reunited with their children in foster care. Iron Tribe Network, a social services organization, bought the former domestic violence shelter with the help of a $400,000 grant it received in 2020 from Columbia Pacific CCO. In the fall of 2021, it began welcoming families to Arnold House.

“Our goal is to get parents back to self-sufficiency and out of state services,” said Shawn Bower, Executive Director of Iron Tribe Network. “But it’s the parents that do the hard work to get their kids back by getting into substance use treatment and finding jobs, support networks and stable, affordable housing. We provide a platform for that to happen.”

Housing and healthy communities

Why did Columbia Pacific help fund supportive housing? CareOregon’s family of CCOs has long known that factors outside the traditional health care setting affect the well-being of our members and the broader communities we serve. Drawing on extensive community input, Columbia Pacific has made addressing housing insecurity a key part of its plan for improving member and community health in its three-county region.

Like other parts of the state, the Columbia Pacific region is grappling with issues ranging from a dearth of affordable housing to elevated levels of homelessness. Relative to other states, Oregon has a disproportionately large number of people experiencing homelessness, an estimated 35 out of every 10,000 residents as of January 2020, according to federal data. Experts say the pandemic has only exacerbated the state’s homelessness crisis and pushed many Oregonians to the brink of eviction.

In the Portland metro area, CareOregon responded to greater levels of housing insecurity in 2020 by providing nearly $1.1 million in pandemic-related relief to community-based organizations working on multiple fronts. With our support, local organizations helped vulnerable Oregonians stay in their homes or find shelter, get safe delivery of food, access telehealth, and provided COVID-safe medical care to people living on our streets, among other critical services.

JOIN, for instance, used CareOregon relief funds to ramp up its efforts to keep people housed during the initial phase of the pandemic when job losses, health care challenges and the closure of schools and child care programs hit many families hard. With a $25,000 grant from CareOregon, the Portland-based nonprofit was able to pay for move-in costs and provide rental assistance to more than dozen households served by the Oregon Health Plan (OHP). It also provided safe delivery of food boxes and purchased mobile phones and laptops for OHP member households, helping them to access care digitally, combat social isolation and stay connected to JOIN’s Outreach and Retention workers. Our support also helped JOIN meet the skyrocketing demand for food and other basic services at its day center for individuals experiencing homelessness.

Jackson Care Connect responds to multiple crises

In Oregon, housing insecurity isn’t just a big city issue. In fact, only 25% of Oregonians experiencing homelessness are concentrated in the Portland metro area, according to state data. Most families experiencing homelessness (more than 3,000 people) live in coastal communities or southern Oregon.

Southern Oregon's housing crisis was laid bare in 2020 by the pandemic and the destructive Almeda wildfire. Even before the blaze destroyed more than 2,300 residential structures - most of them affordable housing - the rental market had a slim, 1.5% vacancy rate. The loss of affordable housing has forced many people out of the region and, a year after the fire, hundreds are still living in hotels.

Jackson Care Connect invested some $2 million in 2020 to address the region’s housing challenges, including $500,000 in fire relief and affordable housing support. A portion of that, $50,000, helped fund a new position at the Housing Authority of Jackson County focused on the development of mobile and manufactured homes, a critical piece of the affordable housing puzzle.

Columbia Pacific puts its housing impact fund to work

For Columbia Pacific, 2020 was a pivotal year when it came to addressing the housing needs of Northwest Oregon, where developable land is in short supply and the proliferation of short-term vacation rentals has reduced the limited stock of affordable rental homes for lower-income residents.

In 2020, Columbia Pacific seeded its newly created Regional Housing Impact Fund with nearly $2 million. It also made its first grants from the fund, totaling more than $870,000. One of the largest grants, $400,000, was awarded to the Northwest Oregon Housing Authority for the development of a 42-unit affordable apartment community in Clatsop County. Once complete, Trillium House at Chelsea Gardens will offer multiple layers of assistance to tenants earning less than 60% of area median income.

Shaped by extensive community input, Columbia Pacific’s housing fund seeks to amplify its impact by making grants that allow recipients to attract additional financial support and/or buy property that might otherwise be sold to commercial interests.

Its grant to Iron Tribe Network helped the organization buy Arnold House with a limited amount of bank financing, and thus hold down its operating costs. With the purchase of the property, Iron Tribe Network can now serve a larger number of families in Columbia County.

“After several years of gathering feedback from key stakeholders on the housing needs in our region and refining our approach to housing, we began to deploy capital in 2020 that’s making a real difference in the lives of some of the most-vulnerable Oregonians,” said Nancy Knopf, Community Health Partnership Director.


Housecall Providers’ COVID-19 task force meets for the first time

The Housecall Providers leadership team met with a big task in front of them. With the first U.S. COVID case confirmed, the novel coronavirus was no longer a distant threat. The team knew the virus had the potential to hit their patients, caregivers and staff hard, and they had to make sure they were ready.

The task force's first priority was to secure personal protective equipment (PPE) like gowns, N95 respirator masks and gloves used by medical professionals to minimize the spread of infection. PPE was in short supply nationwide, and for weeks Housecall Providers was only able to obtain small supplies. Eventually, the National Partnership for Hospice Innovation enabled 100 hospice providers across the country to band together and purchase larger quantities.

Creative approaches to address limited supply

In the meantime, Housecall Providers became a community resource for Portland-area adult care homes (ACHs). Volunteer sewing circles provided an abundance of cloth masks, and they were able to share those supplies with ACH owner/operators as well as patients and caregivers in private homes.

In mid-March, in order to prioritize the limited supply of PPE they did have for hospice visits, Housecall Providers made the difficult decision to suspend primary care intakes and house calls for several weeks. Their Advanced Illness Care program, which provides community-based palliative care for the safety net population, also paused new intakes and relied on telephone check-ins and outside visits with patients when weather permitted. Hospice visits continued throughout the pandemic, so they could provide urgent end-of-life care for patients and families.

"Pausing primary care for the first six weeks of the pandemic definitely took its toll. It was heartbreaking to not be able to admit new patients to our primary care service temporarily, and this also affected our bottom line," says Housecall Providers CEO Rebecca Ramsay. "Our focus had to be on those patients who were at the end of life and making sure the available PPE went to our hospice team members, so they could provide care safely."

Managing the precious supply of PPE added a layer of duties for staff, including learning how to properly fit-test N95 masks to each person, and implementing systems to carefully track the supply. Housecall Providers also purchased two ultraviolet ovens, which they used to decontaminate and reuse PPE, stretching its use. This was a process that was temporarily approved by the Centers for Disease Control and Prevention during the low-supply period.

Pivoting to telehealth

Nurse Practitioner Barb Sutton, who provides primary care for Housecall Providers' patients, says she's been doing house calls for most of her career, and notes it's challenging for people to get care even in the best of circumstances. Under the adverse conditions created by the pandemic, it was even harder.

“Lessening that care is devastating, because the need is so great,” she says.

The organization had already planned to implement a telehealth platform by the end of 2020, but once COVID hit, they urgently needed to bump up the timeline. Housecall Providers launched the platform for their primary care practice in an expedited process that took just a few weeks.

Sutton says the success of telehealth visits often depended on in-home caregivers and staff at care facilities. "We have to put a lot of trust in them," she says. She also acknowledges it's been a frustrating and fatiguing time to be a care provider, as no one was fully prepared for the enormity of the pandemic. However, she's also found great reward in being able to help people through these challenges.

Throughout the spring, Housecall Providers primary care visits continued virtually, but by June, once a reliable source of PPE was available, all three programs were able to start doing more in-person visits. Until vaccines were approved, however, concerns remained. "We had to protect staff and patients. We're a vector. We're going into congregate settings, and if our staff gets COVID, they can spread it," Ramsay says.

As the number of COVID cases increased, Housecall Providers began regular COVID testing for all their clinical teams at the end of July. The team set up an on-site testing area in the Housecall Providers parking lot, with the frequency of testing dictated by the level of positivity rates in each county.

Balancing in-person visits and telehealth

With metro-area clinics relying on telehealth to give care, many patients no longer needed to leave their home to see their primary care provider. Thus, referrals to Housecall Providers primary care service dropped in 2020.

When in-person visits resumed, many providers and clinicians were thrilled to see patients in person again, even with the barriers of masks and protective shields and the discomfort of suiting up in full PPE.

With so many patients who are homebound and isolated, the socialization of a house call can be as important to a patient as the physical health care. Sutton even remembers one client reaching up to kiss her face shield because she was so happy to see her.

While they are happy to be making house calls again, care teams are also glad to access the advantages of telehealth. In some cases, it allows them to treat patients more quickly, using a quick video or phone check in, rather than squeezing a rush hour trip into a day that's already filled with patients.

Sutton says she's been able to treat infections she's seen via video and has even diagnosed shingles. She says "having telehealth as an additional access point is so important. It allows us to reach more people."


CareOregon begins expanding telehealth options

In the early days of the pandemic, people everywhere were learning how to juggle work, school and life from the confines of their home, making do with whatever equipment or furniture they already had. CareOregon staff members were also adapting, and when work-from-home measures were put in place, people quickly improvised temporary work settings from home.

Health care providers had a huge challenge of their own: learning how to see and treat patients via telehealth. It was critical to help providers, so they could continue to get members the care they needed in the midst of the pandemic. CareOregon staff quickly navigated the challenges of virtual collaboration to tackle this important project.

New guidance

Prior to COVID-19, the uses of telehealth approved by the Oregon Health Authority (OHA) were minimal, and many clinics were not set up for video conferencing. In early March, however, clinics began asking CareOregon for guidance on how they could use video or phone calls to get members the care they needed, and how to get reimbursement for those services.

Getting telehealth capabilities up and running involved researching what was working for other health care providers, exploring best practices and learning about system capabilities.

Beth Sommers, Director of Network Relations & Innovation at CareOregon, recalls the Centers for Medicare and Medicaid Services (CMS) released an initial round of guidance around telehealth in early March, and CareOregon pulled together a team including representatives from Network and Clinical Systems (NCS), CareOregon lines of business leaders, Information Systems, Operations, and Brand Marketing and Engagement, among others. The team worked quickly to figure out the operational components of implementing this guidance, along with the communication preferences from network partners.

Josue Aguirre, NCS Operations Manager, says the group prioritized finding consistent responses to provider questions. The team brought questions forward so they could be triaged, and evaluated questions based on urgency. All of this informed the guidance CareOregon would send to providers. CareOregon Innovation Specialists, who serve clinics in each region, put together a technical assistance guide, including information on various communications platform offerings, and how providers could integrate telehealth into their workflows.

Stepping up to support providers

Telehealth changes didn’t happen all at once, and the discrepancy between state and federal standards created some temporary inequities in state/federal policy.

Sommers notes that even in this confusing landscape, CareOregon's priorities were clear. She says, "What I continued to hear from leadership was 'we need to do what's right' for network partners for members, for patients. They decided, 'Yes, we're going to take it on.'

“Our operating baseline was that members could get seen and providers could get paid,” she says.

Changes came from OHA nearly every week, as the state responded to provider needs. For example, initially, a virtual visit could only take place from a clinic. That guidance was changed so providers can give a virtual visit from any location.

Opening up new pathways

Prior to the pandemic, there was a small group of billing codes-around 30-that CMS allowed providers to deliver via video or phone. Now they can use nearly any code that makes sense, which has expanded the types of services that can be delivered via telehealth.

The huge amount of work that it took to support telehealth, and the continual refining that is still happening as clinics find the right processes and approach to serve members, has helped open up critical new avenues of care. In the Columbia Pacific CCO service region, members who live in rural or remote regions now can more easily access specialists that previously would have required a trip to the Portland area. Mimi Haley, CEO of Columbia Pacific, says "telehealth has been really amazing in the behavioral health world. Being able to offer specialty services in a new light has really rounded out the services we can offer our members."


CareOregon sends most employees to work from home

Every 30 minutes, day after day in the early months of the pandemic, one CareOregon employee after another pulled up to the loading dock at 315 SW Fifth Ave. An Information Services & Analytics (IS) team member stood ready to pass over desktop setups, complete with dual screens, keyboard, cables and instructions.

IS techs had built and boxed the kits in an assembly line in the Ford-Rankin conference rooms, shortly after March 13, when CareOregon shifted to almost entirely remote work.

"I told them to make it like Ikea: really, really simple and repeatable," says Nate Corley, Vice President, Information Services & Analytics. Speed and simplicity drove his decision to produce a standard kit that would cover all requests. By April 10, IS had delivered 110 kits, was fielding an average of 50 work-from-home calls per day, and on its way to producing 400 more setups.

‘Just keep everybody working’

CareOregon initially planned to leave the office for two weeks, but Corley immediately thought nine to 12 months would be more realistic. The full-on approach had Chief Operating Officer Amy Dowd's support as leaders asked IS for one thing: "Just keep everybody working."

Meanwhile, Steph Sharp, Safety and Preparedness Manager, activated the 12-member Incident Management Team (IMT). Since December 2019, Steph had eyes on the worrisome new virus and was gearing up with business continuity plans.

By February and March, IMT was monitoring national and state public health guidance to advise CareOregon. Rebecca Ray, Enterprise Portfolio Advisor and IMT member, created a dashboard of 150 critical business functions.

After our buildings emptied, 90% of those critical functions were going well remotely; Housecall Providers accounted for 9% of the functions that could not be done from home. The remaining 1% was made up of staff from Facilities (including the Mail Room and Front Desk), IS, Brand, Marketing & Engagement, Human Resources, Finance and Member Engagement.

IMT collaborated with Housecall Providers to overhaul its operations, and with HR to redeploy 28 staffers whose workload changed because of COVID.

With 926 employees at the time, "we moved over 90% of our staff remote," says Sharp, "in under three days." The 500 staff members in the 315 building dropped to fewer than a dozen. IMT and HR developed work-from-home and COVID-19 response protocols, and a process for inhouse contact tracing.

No CareOregon employee was laid off due to the pandemic, says Chantay Reid, Vice President, Human Resources.

Pre-pandemic preparations pay off

Back in 2016, when Corley arrived at CareOregon, he focused on buttressing our business continuity plan. He was concerned about potential disruptions from earthquakes, power outages, snowstorms and political unrest.

Also in 2016, Joe Partridge, Director of Business Continuity, Safety and Facilities, and 20 team members from Disaster Resilience Business Continuity, conducted a risk assessment and business impact analysis. That data, and earlier data, pointed to the same reality: The 315 building and data center were vulnerable to multiple hazards that threatened business resilience.

Sharp credits this measured, multi-year approach of assessment for gaining the support of the CareOregon Board of Directors and officers to invest in measures to create a hardier IS infrastructure. Corley shifted the company to virtual desktops in 2019, and moved offsite data storage from Colorado to a local, world-class center.

The timing of those preparations was fortuitous. While a novel coronavirus was not on the list of possible threats, those steps positioned CareOregon well for the quick, company-wide shift to remote work. The evolution continues, as IS seeks stronger solutions to meet the high demand for video conferencing.

The vast majority of the company logs on each day from homes across Oregon and Southwest Washington because IS quietly and carefully made that possible. In ways essential to remote work, IS, IMT and Facilities enabled us to keep serving members, patients, providers and our community partners in uncharted times, while keeping the CareOregon family safe and connected as one.


Primary care clinics among sites affected by governor’s postponement order

Surgical and non-surgical masks, disposable gloves, goggles, face shields, gowns and N-95s: When Gov. Kate Brown issued Executive Order 20-10, “PPE” went from obscure jargon to everyday language.

The PPE-conserving order called for postponing elective and non-urgent procedures. It touched hospitals, surgicenters, veterinary clinics, and, importantly for the CareOregon family, outpatient clinics - including student health centers, dental clinics and community health clinics.

Immediately, our Clinical Integration team in the Portland area asked themselves, “How can we help the provider network successfully and comfortably shift to telehealth?”

In the Columbia Pacific region, telehealth was top of mind, too, along with a host of practicalities. For a short moment, Tillamook County Community Health Centers felt overwhelmed by the immense amount to learn and address. Then they quickly shifted to planning mode, reaching out to us for support with virus testing and helping patients who could not quarantine at home.

Our stance with our provider network was simple, says Maranda Varsik, Columbia Pacific Project Manager, "Whatever you need, let us know." In these unsettled times, we would do whatever we could to be there for them and for our members.


Clinics close to non-urgent care as Brown implores, ‘Stay home, save lives’

After crowds gathered at outdoor attractions around the state over the first weekend of spring break, Gov. Kate Brown imposed stronger social distancing measures to slow the spread of the coronavirus.

Executive Order No. 20-12, known as “Stay home, save lives,” included additional business closures, along with social distancing requirements of at least six feet.

This, Oregon's version of shelter-in-place, listed numerous businesses that had to shut down or - in the case of restaurants - shift to take-out or delivery only. At the same time, closures went into effect for primary care clinics and other places where our members access routine and preventive health care.

"Because of these closures, CareOregon needed innovative care approaches to make sure our members could continue receiving necessary care. We developed an at-risk outreach toolkit that was adopted throughout the state: optimizing telehealth payment and services, supporting NEMT drivers to maximize members' access to those services, ensuring our primary care network stability by doing a provider stabilization fund, and using data to help drive these innovations."
Amit Shah
MD, Chief Medical Officer


CareOregon is honored to partner with Tribes in new IMCE effort

Our expanded contract on April 9 with the Oregon Health Authority (OHA) distinguished CareOregon and Oregon Tribes as early adopters of a new national model, Indian Managed Care Entities (IMCEs). Oregon became one of the first two states to forge an agreement between a Medicaid agency and the state's Tribal entities to evaluate the potential for developing IMCEs.

Following the lead of Tribal stakeholders statewide, the OHA agreement called for CareOregon’s Tribal program to work with Tribal communities, offering technical assistance to any interested Tribes or Tribal health care providers.

Four Tribal entities stepped forward to participate. We started collaborating to create a culturally responsive IMCE assessment process, working with the four to evaluate potential costs and advantages of providing care coordination as an IMCE. This process would also support the entities in assessing and reviewing their own systems, including access to care, quality of care, federal funding, and the Tribal health services and resources available.

The agreement also allowed us to work with the Tribal entities to assess how standing up an Indian Managed Care Entity might complement the broad and robust array of services each was already providing in their communities.

For more info on IMCEs, including an Oregon example, see “Medicaid Managed Care Listening Session.”


CareOregon delivers $31.5 million in provider stabilization payments

Gov. Kate Brown’s Executive Order 20-10 aimed to conserve limited supplies of personal protective equipment (PPE) for urgent and emergency in-person care. Our provider network confronted an immediate need to shift from the usual ways in which it met our members’ health needs. The situation challenged us and other insurers to respond, quickly and creatively, to support the health of the health care sector itself.

As a community benefit organization, the CareOregon family serves the most vulnerable and medically fragile populations in the state. A stable provider network is essential for the health of our members and for us as a business. To help make sure clinics could stay open and our members could access the care they needed, we had to act fast.

With finite resources of shared funds, we focused our support on the clinics that would need it most, across the state. These efforts, though not large enough to buoy the entire medical system, reflect our values and continued efforts to strengthen communities by making health care work for everyone.

“In a time when many clinics were having serious financial crises, and when payors were considering utilization impacts of COVID, we jumped in with both feet and sent pre-emptive payments to help stabilize organizations and minimize the disruption they were already experiencing.”
Robert McConnville
Вице-президент CareOregon по городской агломерации Портленда

Support came from two financial streams

1.Quality pool funds: $3,434,957

Oregon Health Authority (OHA) released 60% of quality pool funds early, giving us flexibility in distributing funds in advance of typical timelines. Payments were based on clinics' performance on OHA's 2019 metrics

2.Provider stabilization funds

Prepayment of services to help offset lost revenue due to utilization declines during the months clinics were closed. We used data to guide funding decisions in each region.

Primary care payments: $7,845,802

  • Based on number of members assigned
  • Assumption of 50% decrease in revenue

Behavioral health payments: $6,759,530

  • Based on modeling on previous utilization
  • Assumption of 30% decrease in revenue

Oral health payments: $3,653,952

  • Based on number of members assigned
  • Assumption of 50% decrease in utilization
    (percentages varied for specialty providers)

NEMT payments: $9,313,694

  • Based on 60% decrease in utilization
  • Costs for no-shows, cancellations and PPE

Stability payment timeline:

  • Mar 31: First request from providers for support received
  • Apr 9: First letter sent detailing support plan
  • Apr 24: First payments sent


Gov. Brown allows dentists and other clinics to provide non-urgent care, with limitations

Dental care is hands on. Doing dentistry over the phone? "It was foreign to not have the patient in a chair in front of you," says Alyssa Franzen, DMD, CareOregon's Chief Dental Officer. "We had never done any kind of phone visits."

That changed in a blink. And by the time clinics with adequate personal protective equipment (PPE) were allowed to re-open May 1 for general care, they’d had about seven weeks’ experience in practicing remotely. (The visits were typically by phone because online presented barriers for many patients.) Dentists were making critical clinical triage decisions as they collected patients’ history, signs and symptoms.

Mostly sight unseen, dentists used that information to decide whether patients needed to come to the office for urgent or emergency care, if patients could handle the problem at home, or if the situation could wait until non-urgent visits resumed.

Then there were practice guidelines to set up for this new frontier. In the summer, CareOregon Dental transitioned to offering certain preventive services through teledentistry. Staff quickly collaborated with federally qualified health centers (FQHCs) on practical questions, says Alexa Jett, CareOregon's Oral Health Integration Manager. They hammered out the types of care that were appropriate to offer remotely, what clinical decision-making could be done, and billing procedures.

Surprising benefits with virtual visits

Selynn Edwards, DMD, the Dental Director at Clackamas County Health Centers, remembers thinking back in March 2020, “Gosh, what can we do by telephone?”

A surprising amount, as it turned out. Moreover, these telephonic visits offered unexpected advantages. Edwards was among those dentists and dental hygienists who overcame early doubts and found that phone visits:

  • Helped establish rapport with members who feared dentists, and paved the way for a less-stressful experience when the patient came to the clinic in person.
  • Helped staff deal with dental emergencies more efficiently. When an emergency patient walked in the door, "instrument trays were ready," says Franzen. "The person could be onsite for a much shorter time."
  • Allowed effective outreach to special groups in the spring, including parents of young children, or patients with diabetes. While those calls weren't billable, clinics could check in with members, offer a caring break from isolation, and let them know the clinic was available for dental emergencies and questions.
  • Reduced the number of patients who needed in-person follow-up visits after an urgent procedure. Staff could assess post-op symptoms by phone, and "many times could answer their questions," says Franzen, "or assure them they were on a normal path."
  • Improved no-show rates when a phone visit preceded an in-person visit. “There sure is a lot of preventive care and trauma-informed care happening when you do the telemedicine visits,” notes Edwards of Clackamas County.

The phone visits helped Edwards recognize the number of patients who were nervous about dental care. During a telehealth call, they could break through those barriers. Patients became at ease as they talked through their issues. And she would conclude by saying, "We've 'met!' I look forward to seeing you in person."

Teledentistry remains useful throughout the year

In May, when clinics could reopen for regular care, they were juggling new protocols, including reduced clinic capacity, continued social distancing and increased room-cleaning procedures.

Teledentistry remained an important tool while office capacity and staffing were reduced, both as an alternative for patients and an aid to clinic procedures under COVID. For example, if adults or parents of young children were not comfortable coming into a clinic, staff could use the phone or online tools to assess and advise them.

Dentists alternated between procedures and phone appointments. This gave exam rooms a break from back-to-back use and reduced staffing needs. Clinics staggered their support staff’s schedules to limit the number of exposures if any COVID-19 cases were to occur. In addition, the Portland tri-county area experienced the same staffing challenges that other dental practices faced nationwide after dental assistants and hygienists left the profession because of varied pandemic-related factors.

Through all the changes, Franzen, the CareOregon Chief Dental Officer, appreciated the flexibility of the dentists and dental hygienists who championed teledentistry, determining what could or could not work remotely, as well as the specialty dental network who stepped up to help CareOregon when FQHCs capacity was limited.

With creativity and a dedication to patients, a hands-on profession found ways to safely continue care for members. Teledentistry challenged the dental community to practice in a new style, and brought unexpected benefits along the way.


High-risk member outreach begins

The fear of a dangerous, highly contagious virus and the sudden changes brought on by the stay-at-home orders made life challenging for all of us in the spring of 2020. However, for people with chronic health conditions, high-risk factors or barriers to health, the stakes were even higher.

Because we serve the most vulnerable and medically fragile populations in the state, CareOregon knew COVID-19 had the potential to hit our membership hard. To make sure members of CareOregon, Columbia Pacific CCO and Jackson Care Connect had the information, supplies, medications and resources they needed to stay safe and manage their health, our Population Health and Care Coordination teams quickly began planning outreach efforts to help members in need throughout all our regions.

By the time COVID hit the United States, it was clear the virus was especially dangerous for senior citizens, people with pre-existing conditions and those with compromised immune systems. CareOregon's population health team triaged members who would be at the highest risk for negative health outcomes from COVID-19, including markers such as age, chronic conditions and disease states like cancer or diabetes. CareOregon's team of medical directors refined those lists, and the team created three prioritized groups of members to outreach.

"It was amazing how quickly we all came together for the sake of our members," says Jonathan Weedman, Vice President, Population Health. "We worked across the organization and across all service areas to pull the data, gather the resources and start helping our members within a couple weeks."

Once the lists were defined, cross-functional and cross-company teams, including staff from regional care teams, pharmacy, panel coordinators and customer service, reached out to members or supported clinics in their outreach to patients. The members with the most complex health histories were called by regional care team members and nurses.

The outreach started in May with the goals of:

  • Providing information about COVID symptoms: going over what to watch out for and reminding them to connect with their primary care provider
  • Staying safe: reminding members of mitigation efforts and helping them connect to telehealth appointments
  • Getting access to care: assuring members that benefits hadn’t changed and they could still get the care they needed
  • Filling pharmacy and medical equipment needs: including 90-day refills on most medications, mail-order service from pharmacies, and medical equipment like syringes, test strips and nebulizers
  • Connecting to additional support: connecting members to resources including food boxes, peer support, technology and more

"The teams learned so much in this process, including how critical the needs for social health were," Weedman says. "While isolated, members needed access to food, housing support and outlets for social connections. The previous cracks in our system related to social determinants quickly became canyons of need."

Especially in the most unstable of times, our member-facing teams are committed to helping, knowing that making a personal call and finding solutions to barriers can go a long way to improving a member’s health.

CareOregon Panel Coordinator Sharon Sands remembers reaching out to a member with many chronic conditions. She says, "He was out of his medications and diabetic supplies, and he was also low on food, had transportation barriers and was very depressed. I was able to get him delivery of regular food boxes and get all of his medications refilled. I also helped him re-engage in his care and arranged transportation to an appointment through Ride to Care. He was so happy by the end of the call!"


CareOregon Advantage wants members to know that while they’re staying at home, we’re still here

As the pandemic and social distancing wore on, CareOregon Advantage wanted to help our members feel connected to their health care and health-affirming activities, even during the governor's "stay home" order. The "Healthy at Home" mailing was our way of letting our Medicare members know they could count on us to support their health in multiple ways.

Members could get a 90-day, mailed supply of many prescription drugs, take part in online Silver&Fit fitness classes, or use their OTC debit card to get over-the-counter wellness and first aid products shipped to their home at no extra charge. And if they needed a friendly, knowledgeable voice to help them through a health care situation, they could connect by phone with our Customer Service staff, health care coordinators or 24/7 Nurse Advice Line.


CareOregon swiftly releases last of nearly $1.1 million in COVID-related grants; continues community giving across our service areas

After the pandemic hit Oregon, it took only a few weeks for the new coronavirus to upend virtually every facet of life here. At CareOregon, we knew we needed to move just as fast to offer members, communities and community-based organizations our support in the face of the wholesale disruption.

In mid-March, after CareOregon shifted to remote work, Shawn DeCarlo, Shared Learning and Grant Evaluation Program Manager, immediately went into high gear. He allocated monies to COVID-related grants, created a trackable, equitable distribution process, and posted an emergency grant application on the CareOregon website.

By April 17, a first round of COVID-19 related grants was out the door. By June 10, CareOregon had awarded our full allocation of $1.07 million, to 68 organizations in the Portland tri-county area.

Meanwhile, our regional coordinated care organizations were also busy. In southern Oregon, Jackson Care Connect awarded $378,000 in emergency COVID-related grants. On the north coast and along the Columbia River, Columbia Pacific CCO awarded $586,886 in COVID-related relief.

"CareOregon had an incredible ability to rapidly respond to the needs of the community," says Chief of Staff Jeremiah Rigsby, "even when anxiety was at its highest." Responding to a company priority, 45% - $450,000 - of the Portland-area grants went to culturally specific organizations, which span race and ethnicity, LGBTQ+ and abilities status.

The emergency grants were part of more than $5 million in overall community giving across the CareOregon family in 2020, including charitable grants and sponsorships.

Responding rapidly to community needs

COVID was an isolating time. But for nearly 900 families with young children in the Portland area, CareOregon helped break up those lonely months with the "Family Care Boxes" project. Our largest COVID grant, $40,000, was to United Way of the Columbia-Willamette, to support Help Me Grow care boxes. CareOregon's donation personalized each Help Me Grow base box with games, books and toys that matched each family's culture.

The boxes were given to families that project partners had identified as those with children ages birth to 5 years, who were economically disadvantaged, experiencing high social isolation due to COVID, and who identified as Black, Indigenous or a Person of Color.

In this joint effort, Health Share bought the base boxes. Clackamas and Washington counties, the city of Portland and Health Share helped assemble and deliver the boxes to nearly 1,600 children. Our culturally specific activities were added to the base boxes of age-appropriate, enriching books and activities (plus toothpaste and toothbrushes!). Depending on the family, the additions might be bedtime songs and stories in Chuukese, a Loteria (Mexican bingo) pictographic game, a piñata-making kit or books celebrating diversity. "Families are encouraged to explore the materials with their children … This provides a special opportunity to connect more deeply," said Help Me Grow's report to CareOregon.

Supporting families - especially families of color during the pandemic - with education and social-emotional development is a CareOregon priority. We know the importance to individual and community health and the disparities these families often face as a result of systemic racism and oppression The COVID pandemic exacerbated these disparities.

Meeting three types of needs in the Portland area

In the tri-county area, our COVID-19 grants were targeted to:

  • Basic essentials. CareOregon believes housing is health, and that nutrition is fundamental to good health. We gave $447,000 to organizations that support secure housing, food and emergency assistance. Examples: Bradley Angle ($25,000), Oregon Energy Fund ($20,000), and Self Enhancement Inc. ($20,000).
  • The viability of partner nonprofits. We gave $482,000 to nonprofits to maintain critical operations, such as program services, outreach materials and employee assistance. Examples: Cascade AIDS Project ($10,000), Ecumenical Ministries of Oregon ($5,000), Northwest Housing Alternatives ($25,000), and Portland Opportunities Industrialization Center + Rosemary Anderson High School ($20,000).
  • Innovative responses to the pandemic. We gave $149,750 to help organizations reduce isolation (Such as the Family Care Boxes), provide on-street medical care to reduce COVID risks, and strengthen families. Examples: Oregon Family Support Network ($20,000),The Arc of Multnomah Clackamas ($14,750), and Portland Street Medicine ($25,000).
Community giving across CareOregon

While we shifted a great deal of our focus to the immensity of COVID, we also stayed engaged in the other community needs that we support. In the Portland area, CareOregon gave $1.45 million in 2020 for housing, education, social determinants of health, and culturally and linguistically specific organizations.

In Clatsop, Columbia and Tillamook counties, Columbia Pacific CCO gave $1.835 million to support housing, chronic disease prevention, suicide prevention, trauma-informed care, and access to behavioral health, primary care, oral health and the social safety net. In Jackson County, Jackson Care Connect dedicated $500,000 to support affordable housing and organizations providing direct fire relief and recovery services to those affected by the fall 2020 fires.

Our commitment to community has earned us recognition by Portland Business Journal as a top Oregon Corporate Philanthropist for the past five years, with peers including Nike, Cambia Health Solutions, Intel and Bank of America.

The recognition feels good. But simply serving Oregonians feels even better; that's why CareOregon exists. In 1994, we were founded to meet the health care needs of low-income Oregonians. Since then, we've increasingly recognized how the health of a community is intertwined with the health of its residents. After the tough times of 2020, we remain fiercely committed to creating quality and equity in individual and community health for all Oregonians.


A landscape image of Mt. Hood covered by clouds and trees with a quote from Julia Pirani, Vice President of Strategic Business Initiatives, that reads: People feel comfortable reaching out to us again and again. Members feel more comfortable, so Tribes are continuing to want to work with us.

Tribal care coordination renews for the fourth year

In July, CareOregon's Tribal Care Coordination role was renewed for the fourth year. Our formal relationship with Oregon's Tribal communities began in 2016, when the nine federally recognized Tribes of Oregon and the Native American Rehabilitation Association (NARA) approached CareOregon with a request that we provide care coordination for the state's American Indian/Alaska Native Medicaid population who were on open card (fee-for-service). Thus began CareOregon's Tribal Care Coordination team.

The work has evolved as we continue to strengthen our partnerships with Tribal communities statewide. Pirani oversees the Tribal Care Coordination team, and she credits the trust established in those ongoing relationships.

"We remain humbled and privileged to have the trust of the nine Tribes, NARA and the Oregon Health Authority (OHA) in offering culturally specific care coordination services to Tribal fee-for-service members," she says. "I'm proud of the partnerships staff have developed with individual Tribes' staff. I expect the curiosity and learnings to continue as the Tribal team continues to grow."

Throughout 2020, that strong foundation was especially helpful as the team helped members navigate the year's challenges. The team worked hard to make sure they were prepared to handle member questions on telehealth, COVID testing and accessing care.

Rising requests for behavioral health care

The multiple challenges confronting society over the past year likely affected Tribal people in Oregon as it did many others. The compound challenges of the pandemic, isolation, fires and more led to many Tribal Care members seeking behavioral health services - some for the first time. Tribal Care Team Supervisor Troy Monserrat-Gonzales says, "A lot of old trauma wounds were coming up in the midst of the pressure cooker we were all under. Some of that was post-traumatic stress disorder, some was manifesting as anxiety or depression, and some meant the need for more substance use treatment."

Behavioral Health Care Coordinator Toby Brooks began his role at CareOregon just two weeks before most CareOregon staff were sent home to work remotely. His extensive background in mental health crisis work and in Native health care allowed him to quickly jump into new projects to help streamline care. The number of providers who will accept fee-for-service OHP is limited, and the challenges of the pandemic further taxed those limited resources. To maximize resources for members, Brooks researched all of the options they could refer members to. In the process, he opened lines of communication with those providers, which helped him to have the most current information so he could better match members with providers.

"I've built a level of trust with these providers so that they want to work with us and with our members, and they know the reasons why it's important," he says. Brooks looks to providers who are culturally competent, and who understand that members may be coping with residual effects of colonization or generational trauma, along with day-to-day problems.

In the early stages of the pandemic, the care team also noticed a rise in interpersonal violence, which is consistent with trends that have been reported nationwide. Brooks built a list of 64 resources from across the state, to help connect people to the resources they need.

"This is not an easy system to navigate. If they are calling us, they want help. Once they call us it's like opening the door to getting the help they need," he says.

Navigating care in a pandemic

In addition to behavioral health care, the pandemic created a deferred demand in dental services. With dental clinics closed to most services in the spring, a lot of oral health care was delayed. That led to increased demand in the late summer and fall, when many dental clinics were able to see patients again.

Adjusting to telehealth also took some time. Monserrat-Gonzales recalls that at first, many members were hesitant to use telehealth services to access health care. For members who may be hesitant to seek care in the first place, overcoming the telehealth barrier can be extra challenging. The care team helped members work through their hesitations.

“That’s helping members making that bridge to get to care,” she says.

For mental health care, Brooks said many members enjoyed using telehealth. They were comfortable accessing care from their homes, and he's happy to reassure members now that telehealth is still available. It also broadened the pool of resources he could draw from, in case a local provider was not available.

Trauma-informed care

Monserrat-Gonzales says her team is inherently trauma informed. The team is adept at recognizing where someone is emotionally and culturally, and they can quickly de-escalate situations and help members feel hopeful. In addition to connecting them to health care, the care coordinators also help members find community resources such as culturally responsive resources or peer support groups.

Brooks says, "When members come to us, the matters they are talking with us about are complex." He's honored to be trusted with that information. "What I love is building those relationships with our members and with our providers, and to be able to finely tune those relationships," he says.

All of this intentional work to build relationships with both members and providers is paying off in terms of quality care. Monserrat-Gonzales says they frequently have members whose care coordination needs have been met, but who later call with new needs. Additionally, members also often refer friends and family to care coordination services. She says, "This is an excellent marker of our success providing trauma-informed, client-centered and culturally responsive care for our members."


CareOregon Dental’s support helps Clackamas County hold outdoor children’s clinic

In a big grassy area next to Gladstone Health Center, squealing children ran through a bubble machine – then headed to tables where nurses and dental staff gave needed immunizations, topical fluoride treatments, toothbrushing lessons, and healthy goodie bags. 

In the throes of the pandemic’s first year, Clackamas Health Centers notched a happy first: Gladstone’s first joint (“integrated”) primary care-oral health event. When Selynn Edwards, DMD, Dental Director of Clackamas Health Centers, caught wind that the primary care side was planning an outdoor children’s clinic, she immediately asked if the dental side could join in. 

As the dental and primary care staff worked side by side at the midsummer event, they got to know each other. This new familiarity paved the way for dental and primary care staff to ask each other questions back at the clinic. 

“It is one thing having all lines of services in the same building,” Edwards says, “but if you don’t know who each other is, it doesn’t feel like integration.”  

CareOregon Dental had reached out as a stabilizing force when clinics were closed to all but emergency and urgent care, and as clinics reopened under new safety protocols. “CareOregon Dental filled a huge gap by providing funding for the dental clinic at the integrated Gladstone health center,” says Edwards, the dental director. That funding, and our presence as an active partner, she adds, gave the federally qualified health center the latitude to think creatively about ways to serve the community under COVID restrictions.  

Cue the bubble machine – and toothbrushing lessons that just might outlast the pandemic. 


CareOregon announces that we’ll continue in maximum work-from-home status through at least the end of 2020

After Oregon counties allowed businesses to re-open, summertime found COVID-19 cases on the rise. The concerning trendline, combined with a predicted October surge, changed CareOregon's plans. We'd intended to begin returning on-site, in waves, in the fall. That became imprudent. Recognizing that near-term certainty would help employees plan for their families' needs, we announced that CareOregon would remain in maximum work-from-home (WFH) status through at least December 31, 2020.

As the pandemic gained force, it brought new challenges, uncertainties, anxieties and changes. To help employees feel informed, supported and safe while working remotely, CareOregon took a number of steps. Some highlights:

  • When employees are far-flung, timely and accurate communication can be more difficult. Leadership teams prioritized internal communications through a range of channels, connecting staff to accurate, up-to-date information. This included the weekly e-newsletter "Briefly" (which frequently featured updates from Eric C. Hunter, President and CEO), a living "COVID-10 Work from Home Guide" on the intranet, virtual All Staff meetings (offering information, insights and a chance to ask questions), and a Q&A inbox.
  • Recognizing that COVID-19 also presented parents and other family caregivers with immense challenges, CareOregon firmly committed to offering employees the flexibility that would allow them to better handle the multiple responsibilities they faced in working from home while schools, child care facilities and other care options were closed.

    Hunter made this clear in his August 6 CEO Update. "We encourage you to work with your manager or supervisor to figure out the best way to get your work done," he wrote, "while balancing all of the issues and needs that accompany working from home."
  • WFH saved commute time but posed the possibility of added out-of-pocket expenses. To help with costs such as faster internet service, home office furniture, higher utilities and office supplies, CareOregon instituted a monthly $60 WFH stipend that began August 31.
  • HR encouraged employees to take care of their physical and emotional health during the pandemic, just as we encourage our members to do. We expanded the range of health-promoting activities that are eligible for a $35 monthly wellness benefit, and reminded staff about their employee assistance benefit.
  • CareOregon had a special in-person culture. In employee engagement surveys, employees remarked on our warm, collaborative work environment and its value in creating a sense of purpose and teamwork. While there's no replacement for dancing along with our float at the Starlight Parade, the wicked-clever Halloween costume contest, or the decadent Cupcake Wars benefiting United Way, we made an effort to stay cohesive while apart.

    The SPIRITED committee organized competitions around artistic face masks, a team trivia scavenger hunt and talent videos. They brightened staff mailboxes with a care package that included a card, "encourage-mints" and a CareOregon face covering. And when the Rose Festival Grand Floral Parade shifted to a Porch Parade and a virtual shoebox #ParadinginPlace event, our own parade committee kicked off an employee contest for Best Porch and Best Petite Float. Employees took advantage of opportunities to enjoy each other even while apart.

The CareOregon Board of Directors and leadership team appreciate the hard work, good humor and adaptability of our staff across the CareOregon family. Because of them, we were able to continue serving our members, at a high level, during unsettled and trying times. Each day, we had new opportunities to live up to our SPIRITED values of Service, Passion, Initiative, Results, Innovation, Teamwork, Equity and Diversity.


Community Engagement Team begins a series of virtual support events for members

Normally, the Community Engagement Team is busy helping members at events throughout the community. With new safety restrictions made necessary by COVID-19, however, most of those events were canceled. To make sure we could still help members enroll in the Oregon Health Plan (OHP), navigate their benefits and get their questions answered, the team met members virtually at events throughout the fall and winter, starting with this one at the Portland Rescue Mission.


Wildfires roll across Oregon, destroying thousands of homes

While Oregonians have increasingly come to expect dry summers with high temperatures and smoky skies, 2020 included fires that were more dangerous than anyone expected. On September 8, a lethal combination of high winds and newly sparked fires devastated large areas across the state, as rapidly moving fires destroyed 4,000 homes and killed nine people. The fires and hazardous smoke levels they created affected all of CareOregon's service areas and left many wondering if these devastating conditions would be part of our new "normal."

In Tillamook County, members were evacuated due to fire danger, and Columbia Pacific CCO helped arrange for temporary hotel stays for those with respiratory problems due to heavy smoke levels. In Clackamas County, CareOregon provided relief supplies like clothing, bedding and food to organizations supporting fire evacuees. They also offered virtual OHP enrollment and navigation support to evacuees in temporary shelters.

Tribal Care Coordination helped members across the state get refills on medications they left behind when they were evacuated. This involved working with out-of-area pharmacies that could support members while they were displaced.

Almeda fire causes heartbreaking destruction

Our members in Jackson County were the hardest hit, as the devastating Almeda fire ripped through the towns of Talent and Phoenix, destroying more than 2,400 homes in one day. Another 33 homes were lost in the Obenchain fire near Butte Falls.

About three-quarters of the homes lost were affordable housing units including mobile homes, manufactured homes and apartments. Three groups were disproportionately affected: the Latinx community, senior citizens and low-income individuals.

The entire community felt those losses, including Jackson Care Connect staff, as we saw the unimaginable destruction our family members, neighbors and communities endured. We knew many members would be among those who lost homes, and we immediately reached out to partners and members to offer help. That included working at The Connection Station at the Jackson County Expo Park, which was quickly established as a one-stop shop for fire survivors and evacuees. Staff helped members get refills on medicine, replacement medical equipment and connections to community resources. The Community Engagement Team also helped organize a Latinx workgroup, helping ensure services were linguistically and culturally responsive.

In addition, Jackson Care Connect and CareOregon staff helped house and transport members. We lifted limitations on the transportation benefit, helping members evacuate fire zones. We also found temporary shelter in hotels for 116 members (300 people total, including family members).

Providers also were affected by the fires, as staff lost homes and buildings were affected. La Clinica helped support staff members who lost homes, while they served hundreds of patients who also had lost homes.

To serve fire survivors who needed extra help, Jackson Care Connect partnered with Mercy Flights on the Fire Response Program. Their team of community paramedics served fire survivors with complex needs, including home-bound members. They provided a health risk screening, addressed gaps in care and connected members to support with food, housing or other social needs. By the end of 2020, the program served 328 members, including 188 dual Medicare/Medicaid members.

Committed to rebuilding

The longer road to fire recovery and home rebuilding will take years. Jackson County already had a slim 1.5% housing vacancy rate before the fires, and the destruction of so many properties created an even more urgent need. Knowing the important role stable housing has on a person's health, and the role affordable housing plays in helping our community recover, Jackson Care Connect committed $500,000 in fire relief and affordable housing support. CareOregon and coordinated care organizations Jackson Care Connect and Columbia Pacific CCO will keep working to support members' needs, like safe housing, that affect their health. We will keep finding ways to help ensure our members and communities have the resources they need to keep themselves and their families safe.


CareOregon Advantage mails members a handy care package

In fall 2020, who could use a good face mask, pocket-sized hand sanitizer and nice surprise? Basically, everybody! Last October, as the U.S. was preparing for a fall surge of COVID-19 cases, CareOregon Advantage packaged up two hand sanitizers along with a pair of cheerful orange, adjustable face coverings. We mailed them to our 14,000 Medicare members, with a message reminding them that we are here for them if they need anything.


CareOregon Advantage initiates smartphone pilot to enable annual wellness visits by telehealth

In an ordinary year, an annual in-home wellness visit from a Signify Health provider is a favorite benefit of our Medicare Advantage members. This free visit is 45-60 minutes long, allowing Signify Health's providers to take a full medical history, check vital signs and answer questions in a less-rushed way than a typical clinic visit allows.

Of course, 2020 was not ordinary. And when the pandemic hit, Signify switched to virtual visits. As their staff called CareOregon Advantage members to set telehealth appointments, they heard a continuing theme: "I'm interested. But I don't have the right equipment for telehealth."

The interest in virtual visits was a big shift in preferences for CareOregon Advantage members. In early March 2020, before the pandemic's stay-home orders, we had conducted focus groups and interviews for Medicare members. Back then, members expressed low interest in accessing health care through digital tools such as smartphones, preferring in-person visits.

The about-face was in line with national trends that showed a sharp rise in telehealth services, forced by COVID-19. As CareOregon's Melodie Farmer got the reports from Signify indicating that some members were interested in virtual visits but lacked a smartphone and internet connection, she saw a chance to address the digital gap. Farmer, who's Population Health Quality Manager, asked the Medicare team, "Is there anything we can do to help them get the equipment?" She saw a possibility in flexible Medicare dollars that the Centers for Medicare & Medicaid (CMS) was allowing through the end of the 2020.

After some quick, cross-departmental planning, Medicare Advantage launched a temporary benefit using Health Related Services Funds. In early December, we created a smartphones pilot project. The project reached out to about 225 high-risk members who had told Signify they lacked the equipment to try a video visit.

A pair of Customer Services reps, Nicole Ready and Trisha Diaz, called these members to verify their interest in telehealth and their capability to activate a smartphone. In the end, CareOregon sent a phone and limited data card to about 45% of those members.

In their conversations with the members, Ready and Diaz picked up ideas for ways CareOregon Advantage could offer members additional practical help with using digital technology if circumstances again required remote visits.

"I was really excited to do this outreach," says Farmer, who noted that CareOregon doesn't directly capture data about members' access to a smartphone. In this first time, small-scale effort, we connected dozens of high-risk members for a wellness visit, supporting their health during a time of great isolation and need.