Is health care reform working?
OHSU Center for Health Systems Effectiveness hosts conference to discuss health care reform, share preliminary results
September 25, 2014
Since the passage four years ago of the Patient Protection and Affordable Care Act, the U.S. health care system continues to undergo significant change. Oregon is largely seen as a trailblazing state in implementing health care reform. In particular, Oregon’s model for Medicaid transformation – administered by the Oregon Health Authority and organized around coordinated care organizations (CCOs) – is underway and, if successful, could inform the transformation in other states.
It’s fitting, then, that the state’s only academic health center would be a research nexus for analyzing the unprecedented changes taking place within the Beaver State’s borders. The OHSU Center for Health Systems Effectiveness is taking the lead on evaluating Oregon’s CCOs as well as aspects of the Affordable Care Act.
This type of analysis is essential to ensuring that health care reform lives up to its promise. By 2021, U.S. health spending is expected be nearly 20 percent of the gross domestic product, making solutions to “bend the cost curve” a concern for public and private entities alike. In 2012, John McConnell, Ph.D., director of CHSE and associate professor of emergency medicine, OHSU School of Medicine, received a $2.26 million grant from the National Institutes of Health and a $2.26 million gift from Phil and Barbara Silver to help support OHSU’s long-term capacity to analyze health reform efforts.
During a CHSE conference Sept. 23 – CCOs & Beyond: Health Care Payment Innovation – elected and government officials, researchers, providers, purchasers, journalists and advocates came together to take an early look at the results of that ongoing analysis.
“This is a magical time for health care reform,” said Dr. McConnell. “The system we have now is the one we paid for, and to get a different system we also have to pay for it. This meeting is a chance to take stock, look at the evidence and keep moving forward."
Unsurprisingly, the mechanisms with which we pay for health care were a major theme throughout the day. There was wide agreement that the traditional fee-for-service system, which pays providers for the amount of services they deliver, was a hurdle to true reform. Global budgets, in which providers and, in Oregon, CCOs, are given a fixed amount of money for a specific population, is judged to be a smart alternative – though we’re not there yet.
Dr. McConnell and Deborah Cohen, Ph.D., associate professor of family medicine, OHSU School of Medicine, described the “mixed” methods of their CCO study, which is funded through 2016. Qualitatively, they aim to identify CCO characteristics – governance and geography, for example – that might influence spending and quality outcomes. Quantitatively, they use per capita data from approximately 110,000 Medicaid enrollees to understand CCO effects on spending and quality.
So what do the early data reveal? “We’re not seeing anything dramatic, which is what you’d expect at this preliminary stage,” said Dr. McConnell. “But spending is no longer rising dramatically, which is good. Across the state, CCOs are managed in different ways, which will contribute to the richness of the study over the long term. As an economist, I see the CCO experiment as the largest attempt to slow spending in the nation.”
While change is likely to be incremental and gradual over many years, Dr. McConnell presented preliminary data from 2011-2013 (CCOs began in 2012) that point to interesting early trends in the CCO experiment:
- Spending increased for total acute (non-prescription drug) and inpatient care, procedures, primary care and durable medical equipment
- Spending decreased for emergency room visits, imaging and prescription drugs
- Three CCOs with the highest savings spent less on inpatient care, procedures and imaging, compared with increases in those categories for three CCOs with highest losses
Pictured (top to bottom):Staff from the OHSU Center for Health Systems Effectiveness
(l to r) John McConnell, Ph.D., and Peter Graven, Ph.D.
Dr. McConnell introduced a panel on provider-led payment innovation, featuring (l to r): John Santa, M.D., MPH, director, Consumer Reports Health Ratings Center; Craig Hostetler, MHA, executive director, Oregon Primary Care Association; Karen Shepard, MBA, CPA, chief financial officer, St. Charles Health System; Douglas Walta, M.D., chief executive of clinical programs, outreach and strategy, Providence Health & Services