Oregon’s Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures

McConnell, K. John; Renfro, Stephanie; Lindrooth, Richard C.; Cohen, Deborah J.; Wallace, Nancy; Chernew, Michael E.

doi:10.1377/hlthaff.2016.1298

Cited by 46 publications

(34 citation statements)

References 15 publications

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“…Also, it is the first to examine states’ implementation of Medicaid ACOs over time, which provides important context for interpreting impact results. This study expands the evidence on Medicaid ACO performance beyond previous work by McConnell and colleagues examining Medicaid coordinated care organizations in Oregon, a global budgeting model, that found reductions in expenditures relative to a neighboring state but no reductions in expenditures compared with a state that implemented a regionally based accountable care model, and no evidence on quality of life impacts following implementation of a capitated managed care/ACO hybrid …”

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confidence: 49%

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

et al. 2019

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Maine, Massachusetts, Minnesota, and Vermont leveraged State Innovation Model awards to implement Medicaid accountable care organizations (ACOs). Flexibility in model design, ability to build on existing reforms, provision of technical assistance to providers, and access to feedback data all facilitated ACO development. Challenges included sustainability of transformation efforts and the integration of health care and social service providers. Early estimates showed promising improvements in hospital‐related utilization and Vermont was able to reduce or slow the growth of Medicaid costs. These states are sustaining Medicaid ACOs owing in part to provider support and early successes in generating shared savings. The states are modifying their ACOs to include greater accountability and financial risk. Context As state Medicaid programs consider alternative payment models (APMs), many are choosing accountable care organizations (ACOs) as a way to improve health outcomes, coordinate care, and reduce expenditures. Four states (Maine, Massachusetts, Minnesota, and Vermont) leveraged State Innovation Model awards to create or expand Medicaid ACOs. Methods We used a mixed‐methods design to assess achievements and challenges with ACO implementation and the impact of Medicaid ACOs on health care utilization, quality, and expenditures in three states. We integrated findings from key informant interviews, focus groups, document review, and difference‐in‐difference analyses using data from Medicaid claims and an all‐payer claims database. Findings States built their Medicaid ACOs on existing health care reforms and infrastructure. Facilitators of implementation included allowing flexibility in design and implementation, targeting technical assistance, and making clinical, cost, and use data readily available to providers. Barriers included provider concerns about their ability to influence patient behavior, sustainability of provider practice transformation efforts when shared savings are reinvested into the health system and not shared with participating clinicians, and limited integration between health care and social service providers. Medicaid ACOs were associated with some improvements in use, quality, and expenditures, including statistically significant reductions in emergency department visits. Only Vermont's ACO demonstrated slower growth in total Medicaid expenditures. Conclusions Four states demonstrated that adoption of ACOs for Medicaid beneficiaries was both possible and, for three states, associated with some improvements in care. States revised these models over time to address stakeholder concerns, increase provider participation, and enable some providers to accept financial risk for Medicaid patients. Lessons learned from these early efforts can inform the design and implementation of APMs in other Medicaid programs.

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confidence: 49%

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

et al. 2019

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“…CCOs receive a global budget and focus on primary care through patient‐centered medical homes to improve care for its beneficiaries. Each CCO has its governance from not only health care providers but also members of a community advisory council that ensure community's health needs are met …”

Section: Introductionmentioning

confidence: 99%

“…Medicaid ACOs have been shown to improve access to care and care quality in some areas, for example, increasing in preventive care, decreasing in emergency department visits or inpatient days, and containing cost growth . Few studies have, however, investigated the impact of pediatric Medicaid ACO models on health care utilization, cost, and care quality partly because of modest growth of pediatric ACOs .…”

Section: Introductionmentioning

confidence: 99%

“…[14][15][16][17][18] Medicaid ACOs have been shown to improve access to care and care quality in some areas, for example, increasing in preventive care, decreasing in emergency department visits or inpatient days, and containing cost growth. [18][19][20][21][22][23] Few studies have, however, investigated the impact of pediatric Medicaid ACO models on health care utilization, cost, and care quality [23][24][25] partly because of modest growth of pediatric ACOs. 26 Only one study to our knowledge examined the effect of Medicaid ACOs on childbirth outcomes and found no impact on infant inpatient mortality.…”

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confidence: 99%

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Coordinated Care Organizations and mortality among low‐income infants in Oregon

Bui

Yoon

Harvey

et al. 2019

Health Services Research

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Objective To examine the impact of Oregon's Coordinated Care Organizations (CCOs), an accountable care model for Oregon Medicaid enrollees implemented in 2012, on neonatal and infant mortality. Data Sources Oregon birth certificates linked with death certificates, and Medicaid/CCO enrollment files for years 2008‐2016. Study Design The sample consisted of the pre‐CCO birth cohort of 135 753 infants (August 2008‐July 2011) and the post‐CCO birth cohort of 148 650 infants (August 2012‐December 2015). We used a difference‐in‐differences probit model to estimate the difference in mortality between infants enrolled in Medicaid and infants who were not enrolled. We examined heterogeneous effects of CCOs for preterm and full‐term infants and the impact of CCOs over the implementation timeline. All models were adjusted for maternal and infant characteristics and secular time trends. Principal Findings The CCO model was associated with a 56 percent reduction in infant mortality compared to the pre‐CCO level (−0.20 percentage points [95% CI: −0.35; −0.05]), and also with a greater reduction in infant mortality among preterm infants compared to full‐term infants. The impact on mortality grew in magnitude over the postimplementation timeline. Conclusions The CCO model contributed to a reduction in mortality within the first year of birth among infants enrolled in Medicaid.

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“…Oregon's CCO model is limited to personal health services; however, there are strong incentives to coordinate with social service agencies and invest in public health programs [11]. Under global budgets, CCOs can invest in services that may be more effective at addressing social determinants of health than personal health services typically are [12]. Under these flexible services, CCOs are providing housing supports and services such as transitional housing and home improvements, employment support, education and training, and support groups [13].…”

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confidence: 99%

Accountable Care Communities

Yorkery

2017

North Carolina Medical Journal

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Research has shown that individuals' health outcomes often have more to do with the conditions in which they live, learn, work, and age than the medical care they receive. However, traditional health care is not designed to address the social, behavioral, and economic factors (eg, housing, transportation, access to healthy food, education, and health behaviors) that impact health outcomes. Accountable care communities are showing that it is possible to design systems that are successful at both addressing social and economic factors and improving population health.

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Oregon’s Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures

Cited by 46 publications

References 15 publications

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

Coordinated Care Organizations and mortality among low‐income infants in Oregon

Accountable Care Communities

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