Medicaid alternative payment model leads to large reductions in imaging services

The Alternative Payment and Advanced Care model in Oregon led to fewer traditional visits, more alternative care modes in participating community health centers

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A study published today in Health Affairs shows that an Oregon Medicaid alternative payment model, the Alternative Payment and Advanced Care Model (APCM), led to reductions in traditional in-person primary care visits at that 15 community health centers participating.

The evaluation of the APCM was led by CHSE, OHSU Family Medicine, and OCHIN researchers and found that face-to-face visits dropped by more than 42% after CHCs joined the program, which provided clinics with per-member, per-month capitated payments rather than traditional fee-for-service payments.  The difference in visits was driven entirely by reductions in imaging visits, such as radiographs and ultrasounds.

The research team concluded that the capitated payment model could support clinics in two primacy-care transformation aims: reducing low-value care, and implementing the primary-care medical home model. Clinics participating in the model provide services to more than 150,000 Oregon Medicaid members are accountable for meeting Oregon's Medicaid quality metrics. 

Read the article brief 

View the Health Affairs abstract. 

About the Center for Health Systems Effectiveness

The Center for Health Systems Effectiveness researches health care service delivery with the aim of improving the value and sustainability of the U.S. healthcare system. Our mission is to provide the analyses, evidence and economic expertise to build a better and more sustainable health care system.

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