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 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.
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.
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
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.
In addition to our own research, CHSE collaborates on projects with colleagues in other OHSU centers and departments, sharing methodological and analytic expertise.