Oregon CCO Evaluation
Like most states, Oregon has struggled to provide high-quality care to its Medicaid population in a cost-effective manner. In response, the state recently launched an innovative and substantial restructuring of its Medicaid program, transitioning care into Coordinated Care Organizations (CCOs), regionally-based health care delivery groups comprised of multiple health service organizations. The CCO "experiment" includes an agreement with the Centers for Medicare and Medicaid Services (CMS), in which CMS is providing $1.9 billion to Oregon to assist in its transition. In exchange, Oregon agreed to reduce its rate of spending growth by 2 percentage points without degrading the quality of care. If Oregon does not meet these benchmarks, it will lose hundreds of millions of dollars in payments from the federal government. Oregon is thus the first state to explicitly tackle the health care cost challenge with a global budget that specifically caps the rate of growth for its Medicaid program.
CHSE has received NIH, foundation, and philanthropic funding to identify the impact of the CCO transformation on cost and quality, to identify what works within the Oregon experiment, and to disseminate these findings locally and nationally.
Researchers and analysts at CHSE use econometric and statistical methods to analyze hospital and provider data within OHSU. The goal of these efforts is to identify ways to improve the overall efficiency of the OHSU health care system. CHSE's Healthcare Team reviews hospital cost data to identify procedures with potential for delivery improvements. Our analysts work on an iterative basis with the relevant clinical teams, supply-chain technicians, and other stakeholders to analyze sources of variation and targets for improvement. Projects to date have identified ways to improve discharge processes and purchasing of surgical supplies.
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 to predict the number of providers needed to meet the increased demand.Graven's model estimates the number of new providers needed from 2014 to 2020 given changing demand as well as shifting systems of care delivery such as 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.
Why is the quality of care at some hospital 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.
South Dakota Health Survey
With the advent of the Affordable Care Act, the time is ripe to ensure that states have programs in place to provide optimal health services to everyone, regardless of where they live.
However, connecting to services can be especially challenging for those in rural areas, which are prominent in states like Oregon and South Dakota. In rural areas, the shortage of health care providers, distance between locations, cultural factors, and other barriers may complicate health service delivery. The first step to improving care is to establish baseline data about the underlying prevalence of health conditions and overall access to services.
To this end, CHSE is conducting a multi-step survey and analysis that will close the data gap in South Dakota with the potential of expanding into other states. Our goal is to gather the high-quality data needed to inform innovative service delivery models in South Dakota and similar areas across the nation.
To ensure this study includes populations that are often under-represented in survey data, OHSU is partnering with local stakeholders who have experience working with South Dakota's rural populations. We are also engaging each of the nine American Indian tribes in the state, individuals and families experiencing homelessness, immigrant and refugee communities, and other populations whom standard survey methods may not reach.
This project is based on a collaboration with 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. This 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.