Editorial: Paying to improve Oregon health care

Published 10:12 am Friday, December 19, 2025

By the Bulletin Editorial Board

The Oregon Health Policy Board meets in December to discuss metrics for Medicaid and other matters. (Oregon Health Policy Board)

Health care in Oregon is a blend of the wondrous, the once wondrous that is now routine, and the wrong.

Through the Oregon Health Plan— the state version of Medicaid — the state is trying to nudge more care toward higher quality. It is paying for performance. It’s doing that by setting measures for coordinated care organizations, or CCOs.

CCOs are the health care entities that provide most of the care in Oregon for the Oregon Health Plan. CCOs can earn bonus dollars on top of what they get paid for serving their populations by hitting state goals. If they improve quality of care, they can get more money.

The bonuses are significant. The peak was about $300 million available. PacificSource, which operates the CCOs for the area that includes Clatsop County Health and other parts of the state, was awarded about $48 million more in 2024 because of its performance on state metrics.

No CCO met all of the performance measures in 2024.

For 2026, the discussion has been to set measures for immunization rates, preventative dental care rates for children, treatment and identification of substance abuse and more. There is also a measure that tries to get at the need to ensure young children get assessed and treatment for any possible social or emotional delays that may impede their development.

There has been concern across the country that pay for performance may result in gaming the system to ensure better performance on the identified metrics — and maybe less effort in other areas.

In Oregon, it does clearly incentivize that CCOs go after improving the specified metrics and focus on improving quality of care. It does seem to work.

Child immunization rates remain a notable concern.

Of course, it’s not clear how much progress would have been achieved without the incentives. And it’s never easy to disentangle what unfortunate impacts the incentives may have.

Pay for performance does make it all the more important that Oregon very carefully choose the metrics identified for incentives.

Tell the Oregon Health Policy Board what you think of the state’s metrics. You can find more discussion about 2026 metrics here: tinyurl.com/ORpfp2026 and information about 2024 here: tinyurl.com/ORpfp2024.