Oregon 2026 CCO Metrics — THW/Peer Code Mapping

Oregon 2026 CCO Incentive Metrics — THW/Peer Code Mapping

Oregon Erratics LLC | Source: OHA 2026 Incentive Measures (Dec 2025) × HEDIS QRS MY2026 Value Sets × OHA BH Peer Fee Schedule (Feb 2026)
Direct Peer code appears in HEDIS value set for this measure
Supporting Peer activity supports the measure but code not in value set
Indirect No direct peer coding pathway; upstream support only
★ 2026 Challenge Pool measure
ID Measure Name Purpose / What It Measures THW Role Peer Codes (Direct) Supporting Role
IET
 Initiation & Engagement of SUD Treatment % of new SUD diagnosis episodes resulting in treatment initiation within 14 days AND continued engagement within 34 days. Two-part measure; must meet both. Direct H0039 Assertive community tx
H2014 Skills training
H2011 Crisis intervention
G0177 BH training/education
All via BH Outpatient value set
⚠ H0023, H0038 not in IET value sets
 H0023 outreach drives pre-diagnosis engagement; warm handoffs to SUD tx initiate the 14-day clock. H0038 peer support sustains engagement through the 34-day window.
FUH
 Follow-Up After Hospitalization for Mental Illness % of discharges from inpatient psychiatric stays with follow-up visit within 7 and 30 days. CCO contract metric (not 2026 incentive list but contractually tracked). Direct H0038 Peer support (15 min)
T1016 Case management
H0039 Assertive community tx
H0046 MH services NOS
H2014 Skills training
H2023 Supported employment
G0177 BH training/education
Via Peer Support Services + BH Outpatient value sets
 Strongest peer coding opportunity. A billed H0038 or T1016 visit within 7/30 days of psych discharge = qualifying follow-up. Peer navigators bridging hospital to community directly move this metric.
DSF-E
 Depression Screening & Follow-Up ★ % of patients 12+ screened for depression using standardized tool AND, if positive, follow-up plan documented at same encounter. eCQM measure; benchmark 77.1%. Direct T1016 Case management
H0039 Assertive community tx
H2014 Skills training
G0177 BH training/education
T1016 via Depression Case Mgmt Encounter value set
Others via Behavioral Health Encounter value set
 T1016 case management visits can be the qualifying follow-up encounter after a positive screen. Peers can document follow-up plan support within their scope.
SDOH
 Social Needs Screening & Referral CCOs must conduct equitable, trauma-informed social needs screening AND work with CBOs for referral capacity AND support data sharing between CCOs, providers, and CBOs. Supporting No peer HCPCS codes in HEDIS value sets Peer workers conduct SDOH screening in community settings. CBOs (OE partners) are the referral network CCOs need to attest. OE's CBO infrastructure = the system CCOs need to meet attestation. UniteUs/closed-loop referrals fulfill data sharing requirement.
GSD
 Glycemic Status Assessment (Diabetes) % of patients 18–75 with diabetes with HbA1c >9.0% during measurement period. Benchmark: 19.5% (2024 CCO 90th pctile). Lower = better (identifying poorly controlled DM). Supporting None Peer health coaches/CHWs support medication adherence, lifestyle behavior, and care navigation for members with DM. OE's CLIA point-of-care capability could support testing workflows.
MLA
 Meaningful Language Access (Health Equity) Proportion of visits with spoken/sign language interpreter needs provided with OHA-qualified interpreter services. Two-component measure. Health equity measure. Supporting T1013 Interpreter services ($67.35)
On OHA peer fee schedule; may qualify
 T1013 (sign language/oral interpreter) is on the OHA peer fee schedule. If OE partners serve linguistically diverse populations, proper T1013 billing supports CCO attestation.
SEI
 Social-Emotional Intervention/Treatment (Ages 1–5) % of children ages 1–5 receiving issue-focused intervention/treatment services. Benchmark: 12.0%. Kindergarten readiness strategy. Supporting None direct Family peer support specialists and parent peers can support engagement with social-emotional treatment services. No peer billing code maps directly to this measure.
ACO
 Assessments for Children in ODHS Custody % of children 0–17 in foster care with physical (30 days), dental (30 days), and mental health (60 days) assessments after placement. Benchmark: 80.0%. Supporting None direct Peers with lived child welfare experience can support family engagement, navigation to assessments, and follow-through. High-trust, high-need population well-suited to peer model.
CIS
 Childhood Immunization Status (Combo 3) % of children turning 2 with Dtap, IPV, MMR, HiB, HepB, VZV, PCV vaccines by 2nd birthday. Benchmark: 68.9% (national Medicaid 75th pctile). Indirect None Peer outreach can improve immunization rates in hesitant or hard-to-reach families. Not a coding pathway — population health role only.
AWC
 Child & Adolescent Well-Care Visits ★ % of children ages 3–6 with one or more well-child visits with PCP during measurement year. Benchmark: 75.3% (2024 CCO 90th pctile). Kindergarten readiness strategy. Indirect None CHWs/peers can support families in scheduling and attending well-child visits, particularly for OHP members with transportation or access barriers.
IAD
 Immunizations for Adolescents (Combo 2) % of adolescents turning 13 with meningococcal, Tdap, and HPV vaccines by 13th birthday. Benchmark: 41.6% (national Medicaid 75th pctile). Indirect None Peer/CHW outreach to families, appointment navigation. No direct coding opportunity.
PPC
 Prenatal & Postpartum Care (Postpartum Rate) % of live birth deliveries with postpartum visit 7–84 days after delivery. Benchmark: 91.1% (national commercial 75th pctile). Indirect None CHW/doula support for postpartum visit attendance. Not a peer coding pathway; population navigation role.
PDO
 Preventive Dental/Oral Health Services ★ % of enrolled children ages 1–5 and 6–14 with preventive dental/oral health service during year. Two-component. Kindergarten readiness strategy. Indirect None Peer/CHW appointment navigation and transportation support for families. No direct coding pathway.
Key finding: Three Oregon CCO metrics have direct peer billing pathways: IET (H0039, H2014, H2011, G0177), FUH (H0038, T1016, H0039, H0046, H2014, H2023, G0177), and DSF-E (T1016, H0039, H2014, G0177). FUH is the strongest — H0038 and T1016 (OE's core codes) are qualifying encounters. Critical gap: H0023 (peer outreach) does not appear in any HEDIS value set — a policy argument for OHA/PMS: outreach that initiates SUD treatment should count toward IET initiation.

Data sources: OHA 2026 CCO Incentive Measures & Benchmarks (updated Dec 24, 2025) | HEDIS for QRS MY2026 Value Set Directory (2026-03-31) | OHA BH Fee Schedule Peer-Delivered Services (Feb 2026) | Analysis by Oregon Erratics LLC / Crow, May 4, 2026.