State Innovation Model Evaluation
One of the underpinnings of Oregon's Medicaid transition into coordinated care organizations has been the idea that its features would eventually spread to populations receiving their care through non-Medicaid payers. On this
project, CHSE joins forces with the Providence Center for Outcomes Research and Education (CORE) to gauge the
extent of this "spillover" effect and see where and how it is occurring.
While CORE carries out qualitative observations around the state, CHSE will use Oregon's All Payer All
Claims database to analyze patterns of care between providers with panels comprised of higher and lower proportions of Medicaid members, looking for evidence of CCO-like care to non-Medicaid patients.
South Dakota Health Survey
Connecting with health care services can be especially challenging for those in rural areas, where shortages of health care providers, distance between locations, cultural factors, and other barriers may complicate service delivery. The South Dakota Health Survey aims to establish baseline data about health conditions and access to services through a multi-step statewide survey and analysis.
To ensure the study includes populations that are often under-represented in survey data, CHSE is partnering with local stakeholders who have experience working with South Dakota's rural populations and is engaging each of the nine American Indian tribes in the state, individuals and families experiencing homelessness, immigrant and refugee communities, and other hard-to-reach populations.
Collaborators include the Providence Center for Outcomes Research and Education (Providence CORE), which conducted the landmark Oregon Health Study, as well as Dr. Donald Warne, Associate Professor and Director of the Master of Public Health Program at North Dakota State University. All together, the study represents one of the most comprehensive assessments of statewide health conditions ever conducted, with significant potential to analyze subgroups and rural communities.
Funding for this project has been provided by The Leona M. and Harry B. Helmsley Charitable Trust.
Influences of the Coordinated Care Model on Individuals Dually-eligible for Medicare and Medicaid
Among the many people affected by Oregon’s Medicaid reforms is a smaller, distinct group of individuals who also qualify for federal Medicare benefits. These individuals draw attention from policy-makers in part because they account for approximately one-third of Medicaid expenditures even though they comprise only 14% of Medicaid recipients. Also, financing by both Medicaid and Medicare creates the potential for fragmented care. Unlike most Medicaid enrollees, those who are dually eligible for Medicaid and Medicare are not automatically enrolled in Oregon's coordinated care organizations.In this study, CHSE economist Hyunjee Kim will look at how Oregon’s coordinated care transformation is affecting this population. Funded in part by the Oregon Medical Research Foundation and in part by the Oregon Health Authority, this work will shed light on levers affecting care for the dually-eligible under coordinated care and accountable care payment structures.
Hospital Transformation Performance Program Evaluation
Recognizing the role hospitals play in health-systems transformation, the 2013 Oregon Legislature initiated a pay-for-performance program aimed at improving quality of care in 28 of the state's largest hospitals. This initiative, labeled the Hospital Transformation Performance Program, offers financial incentives to hospitals that improve their performance on 11 quality metrics over a two-year period. CHSE will evaluate the program's effect on the 11 key metrics, which range from hospital-acquired infection rates to patient experience ratings. The team will also assess the extent to which HTPP resulted in investments and changes within hospitals aimed at improving quality and measurement capacities.
Bridges Health Evaluation
Oregon's health reforms have spurred development of many "hotspotting" interventions designed to reduce expensive utilization, such as inpatient and ED admission, through delivering coordinated care to patients with avoidable use of these services. Evaluating the effectiveness of these interventions is tricky, however, since it's difficult to tease apart impacts of the intervention from other concurrent changes or regression to the mean.
CHSE's evaluation of the new Bridges Health coordinated-care model avoids these shortcomings by incorporating a control group drawn from the Oregon All Payers All Claims (APAC) database. PI Peter Graven, in collaboration with Mosaic Medical and PacificSource, will match patients from the Bridges Health Clinic "super-user" coordinated-care program with similar (deidentified) patients from APAC, allowing the team to identify changes in service utilization due solely to the intervention.
Support for the project comes from the Oregon Clinical and Translational Research Institute in collaboration with the Central Oregon Research Coalition.
Sustainable Health Expenditures Workgroup support
In 2014, Oregon joined other states – including Vermont, Massachusetts, and Maryland – in attempting to calculate health care expenditures across payers and come up with a comprehensive total that can be adjusted to benchmark year-to-year growth. The Oregon Health Authority has engaged CHSE to develop a methodology spanning diverse payers and populations across the state. CHSE delivered an initial report in December 2014 and is continuing to refine its approach to inform the Oregon Health Policy Board’s work toward a “fixed and sustainable” rate of health expenditure growth.
Health Evidence Review Commission supportWhile Oregon’s Health Evidence Review Commission has lots of tools to evaluate the clinical merit of different treatments, it has had fewer resources for learning the number of Oregonians whose care would be affected by a particular set of guidelines. Using the All Payer All Claims database, CHSE is now able to estimate current and future use of different treatments and technologies, allowing HERC to choose projects where its work will have highest impact.
Oregon Health Care Workforce Project
With the Affordable Care Act ushering thousands more Oregonians onto health-insurance policies in 2014, the state's demand for health care can go nowhere but up – not to mention the already increasing demand from a growing and aging population.
To determine the readiness of Oregon's health care workforce, the Oregon Health Authority asked CHSE health economist Peter Graven and the Oregon Healthcare Workforce Institute to predict the number of providers needed to meet the state's primary-care needs between 2013 and 2020. Graven's model projects the number of new providers required county-by-county, taking into account changing demand as well as shifts in care delivery toward more team-based care, greater use of non-physician care providers, and the growth of telemedicine and health-information technologies.The project is innovative in its use of the Oregon All Payer All Claims Database to estimate flows of patients across the state.View project report
Why is the quality of care at some hospitals better than others? Researchers and policy makers have recently focused on the potential role of management. Proponents of "Lean" management and related approaches point to the apparent success of these applications in selected case studies, such as Virginia Mason or Denver Health. However, information is still scarce about the dissemination and use of these practices, and the evidence base about the relationship between modern management practices and patient outcomes in the United States is lacking. Using an innovative survey design originally developed for and validated on manufacturing firms, CHSE has gathered data on more than 600 cardiac units, covering Lean management, target setting, and incentives for employees. These data are being used to assess the relationship between "good" management, quality of care, hospital market share, and cost.