Umpqua Health

What Umpqua Health does

Umpqua Health is a private, Oregon-based Coordinated Care Organization (CCO) that administers Oregon Health Plan (Medicaid) benefits for members in Douglas County under a contract with the Oregon Health Authority. Founded in 2012 and headquartered in Roseburg, the company (legal entity Umpqua Health LLC, doing business as Umpqua Health Alliance) integrates medical, behavioral health, dental, pharmacy, and specialist services through a contracted provider network, supplemented by a wholly-owned Rural Health Clinic (Newton Creek) and direct member services including a 24/7 nurse hotline, non-emergency medical transportation, and interpreter access. The company has expanded its scope under Oregon's 1115 Medicaid Waiver to deliver Health-Related Social Needs (HRSN) benefits covering housing, climate (heating/AC), nutrition, and outreach, and administers a Quality Incentive Program (QIP) tied to performance on metrics such as diabetes care, immunizations, and social-needs screening.

Revenue is generated through capitation payments from the Oregon Health Authority, performance-based QIP incentive payments, and pass-through grant funding such as the 2025 Community Capacity Building Funds ($2,024,611) earmarked for HRSN provider network development. Go-to-market is effectively non-traditional: enrollment is mediated by the Oregon Health Plan, while provider contracting and HRSN network buildout are executed through direct sales and channel partnerships. The technology stack is anchored in CMS-mandated interoperability — a patient-facing health information API (Edifecs-powered, with data from 2017 onward) and a FHIR-based Provider Directory API — with prior authorization tracking scheduled for January 2027. Strategic partners include the Oregon Health Authority (core), Oregon Wellness Network, YMCA of Douglas County, and the multi-state West Coast Health Alliance.

Name

Umpqua Health

Legal name

Umpqua Health LLC

Website

https://umpquahealth.com

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

101–250 employees

Short description

Umpqua Health is a private Oregon Coordinated Care Organization that administers Oregon Health Plan (Medicaid) benefits for Douglas County members, integrating medical, behavioral, dental, and pharmacy services with Health-Related Social Needs supports under a contract with the Oregon Health Authority.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Services-Offices & Clinics Of Doctors Of Medicine (8011)

akta.pro primary industry

Medicaid Managed Care HMOs (HLAEAMAI)

Keywords

• Medicaid managed care
• Coordinated care organization
• Behavioral health services
• Healthcare provider network
• Social determinants of health

Headquarters

HQ city

Roseburg

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Medicaid/CCO Revenue: Umpqua Health operates as a Coordinated Care Organization (CCO) receiving capitated payments from Oregon Health Authority for managing Oregon Health Plan (Medicaid) members in Douglas County.
2. Quality Incentive Payments: Performance-based payments through Oregon's Quality Incentive Program (QIP) tied to meeting quality metrics and benchmarks.
3. Community Capacity Building Funds: Grant funding from OHA for building HRSN service provider networks ($2,024,611 available in 2025).

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels3 records

Core offering

Umpqua Health operates as a Coordinated Care Organization (CCO) delivering Oregon Health Plan (Medicaid) coverage to members in Douglas County, Oregon. The plan integrates medical, dental, behavioral health, and pharmacy benefits through a contracted provider network, with added Health-Related Social Needs (HRSN) services such as housing, nutrition, and climate-related supports.

Product overview

Umpqua Health (Umpqua Health Alliance) is a Coordinated Care Organization (CCO) providing Oregon Health Plan (Medicaid) coverage for Douglas County, Oregon. The organization operates as a platform offering integrated health benefits through a network of providers. The core product is the Umpqua Health Alliance health plan, which bundles medical, dental, behavioral health, pharmacy, and specialist services. Supporting services include the Newton Creek Rural Health Clinic (providing primary and urgent care regardless of insurance), Nurse Hotline, Transportation Services, and Interpreter Services. Under the Health-Related Social Needs (HRSN) Program, the organization offers housing, climate (AC/heating), and nutrition supports. The Flexible Services program provides supplemental non-covered benefits. Additional programs include the Quality Incentive Program (QIP), Community Capacity Building Funds grants, Health Information Technology/Patient Access API for interoperability, Diabetes Prevention/Management Program, and Health Care Interpreter Training. The organization operates Edifecs-powered member portals and exposes a CMS Provider Directory API for provider data.

Differentiator

Problem solved

Functional benefit

Quantifiable outcome

• Over $300 million in QIP bonus payments distributed to Oregon CCOs in 2024
• +1 more outcomes

Named customers2 records

Segments2 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration4 records

Feature3 records

Partnerships

Five partnerships are on record, tiered core and minor.

• Oregon Health Authority (OHA)coreStrategic or Co-development PartnerPrimary regulatory partner and health plan funder. OHA contracts with Umpqua Health as a Coordinated Care Organization (CCO) to manage OHP members, provides Quality Incentive Program funding, and oversees HRSN program implementation under Oregon's 1115 Medicaid Waiver.
• Oregon Wellness Network (OWN)coreStrategic or Co-development PartnerPartnership for diabetes prevention and self-management education programs. OWN delivers National Diabetes Prevention Program (DPP) and Diabetes Self-Management Education and Support (DSMES) services to Umpqua Health members through certified lifestyle coaches and educators.
• YMCA of Douglas CountyminorChannel Partner/ Reseller/ DistributorGym membership partnership for member wellness. Umpqua Health refers members to the YMCA for covered fitness memberships as part of flexible services benefit.
• West Coast Health AllianceminorStrategic or Co-development PartnerMulti-state health alliance with Washington, California, and Hawaii for coordinated public health response and evidence-based healthcare information sharing, particularly during public health emergencies like COVID-19.
• HRSN Service ProviderscoreChannel Partner/ Reseller/ DistributorNetwork of community organizations contracted to deliver Health-Related Social Needs services including housing assistance, nutrition programs, climate services (AC/heating), and outreach and engagement for eligible OHP members.

Scale indicators3 records

Recent moves6 records

Expansion highlights6 records

Broad incumbents

• Molina Healthcare: A national managed care company with a heavy Medicaid focus across many states, including government-sponsored health plans. Broad incumbent because it competes in the same Medicaid managed care category as Umpqua Health but at vastly greater scale and geographic breadth, and could plausibly bid for Oregon CCO contracts.

Others

• Centene Corporation: The largest Medicaid managed care organization in the United States, with subsidiaries operating state Medicaid contracts nationwide. Broad incumbent because it competes in the same Medicaid MCO category as Umpqua Health at national scale and could be a counterparty in any Oregon CCO re-procurement.

Direct peers

• CareOregon: A nonprofit Medicaid health plan serving OHP members across multiple Oregon counties, including through its CareOregon Advantage Medicare plan. Direct peer because it is one of Oregon's most established CCO operators with the same regulatory model, OHA contract structure, and HRSN program exposure as Umpqua Health.
• Cascade Health Alliance: A small Oregon CCO serving Klamath County OHP members. Direct peer because it operates the same single-county CCO model as Umpqua Health, with a comparable rural community focus, member scale, and HRSN program exposure.
• AllCare Health: A Coordinated Care Organization serving OHP members in Jackson, Josephine, Curry, and parts of Douglas County. Direct peer because it is a similarly-sized, community-based Oregon CCO with comparable member services, provider network model, and quality incentive program participation.
• Yamhill Community Care Organization: A Coordinated Care Organization serving OHP members in Yamhill County and parts of Washington and Polk counties. Direct peer because it operates the same single/limited-county CCO framework with comparable administrative scale, quality incentive exposure, and HRSN integration.
• Advanced Health: A Coordinated Care Organization serving OHP members in Coos and Curry counties on the southern Oregon coast. Direct peer because it is a similarly-sized rural Oregon CCO with a comparable community-based model and overlapping quality and HRSN program requirements.
• Trillium Community Health Plan: Oregon CCO serving Lane County and parts of Douglas County. Direct peer because it operates the same CCO model, contracts with OHA, and competes for OHP members in a geography that overlaps with Umpqua Health's footprint.
• Health Share of Oregon: A large Oregon Coordinated Care Organization serving OHP members across the Portland-metro tri-county area. Direct peer because it operates under the same CCO regulatory framework, contracts with the same Oregon Health Authority, and serves the same OHP population—Umpqua Health is a smaller, single-county version of this model.
• PacificSource Community Solutions: Operates multiple CCO contracts across Oregon (Central Oregon, Columbia Gorge, Lane, Marion/Polk, and Eastern Oregon). Direct peer because it serves the same OHP Medicaid population under the same CCO framework as Umpqua Health, with overlapping quality programs and HRSN exposure.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Umpqua Health