Current CHSE Research Projects
Oregon CCO Evaluations
Like most states, Oregon has struggled to provide high-quality care to its Medicaid population in a cost-effective manner. In response, the state in 2012 launched an innovative and substantial restructuring of its Medicaid program, transitioning care into coordinated care organizations under a Section 1115 demonstration waiver. CCOs are regionally-based health care delivery networks that provide comprehensive physical, behavioral and dental health care to area Medicaid enrollees in exchange for capitated payments. 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 assess 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. We are also the state's contractor for its formal summative Section 1115 waiver evaluation.
Dental Integration in Oregon Medicaid
"Bringing the mouth back into the body" is how dental researchers often describe the need for integrating oral health care with the other areas of health it affects. Oregon's Medicaid reforms took aim at the traditional divide between dentistry and other health services in 2014 by merging Medicaid's dental budget into the global health care budgets provided to Oregon's coordinated care organizations. In 2015, the state added two metrics for children's oral health services to the benchmarks CCOs must reach to earn quality incentives.
This evaluation project, sponsored by the Oregon Health Authority, assesses early changes in Medicaid recipients' dental care access and use. CHSE will analyze claims for 15 common dental procedures, comparing pre- and post-integration periods. The team will also examine changes in expenditures and in emergency-department visits for dental conditions. The project concludes in late 2016.
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.
Multnomah County Health Chronic Disease Analysis
County health departments play an important role in reducing the burdens of chronic and communicable diseases and, like health systems, rely on data for designing effective programs. Multnomah County asked CHSE to examine Medicaid claims data on 11 common conditions to identify the most cost-effective prospects for associated public health interventions.
Behavioral Health Care Contracting in Idaho Medicaid
Outpatient behavioral health care for Idaho's Medicaid program is currentlycovered through managed care, while inpatient behavioral health care iscontracted separately. Would integratingthe two work better? Using three yearsof claims data, CHSE is analyzing the opportunities and risks involved in a newcontracting approach, including impacts on hospital admissions,behavioral-health-related emergency department visits, continuum of care, andcoordination of inpatient/outpatient services.
Medicare home health care
Economic theory suggests that marketplace actors will respond to new incentives by altering their behavior to maximize profit. CHSE will test how well this theory applies to home health care in this study of how agencies responded to the 2000 introduction of Medicare’s Prospective Payment System. Using Medicare claims, CHSE is exploring the extent to which home health agencies strategically changed service patterns to increase their profit margins, how market structures such as competition rates affect these behaviors, and how cost and quality of patient care may have changed.
In addition to our own research, CHSE collaborates on projects with colleagues in other OHSU centers and departments, sharing methodological and analytic expertise.