CHSE brings together rigorous methodology and economic expertise with large data set analytic capabilities in pursuit of improving the value of our healthcare system. Our faculty and scholars examine issues central to health care service delivery to improve knowledge about delivery system and payment reform, and deliver clear and actionable evidence for healthcare decision-makers.
Medicaid reform in Oregon
Oregon transformed its Medicaid program by creating coordinated care organizations (CCOs), regional networks that are responsible for health care access and quality among their members. Our team has undertaken extensive work to understand the impacts of this novel policy experiment, including comparison of health care quality and spending trends among Oregon's Medicaid members with trends in Colorado and Washington State, which carried out more limited reforms.
- Oregon's Medicaid Coordinated Care Organizations. JAMA, 2016
- Oregon's Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures. Health Affairs, 2017
- Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado. JAMA Intern Med, 2017
- Oregon's Emphasis On Equity Shows Signs Of Early Success For Black And American Indian Medicaid Enrollees. Health Affairs, 2018
- Decomposing Medicaid Spending During Health System Reform and ACA Expansion: Evidence from Oregon. Medical Care, 2018
- Decomposition of Medicaid Spending Changes
- Oregon Medicaid efforts to reduce health disparities
Opioid Prescribing Patterns
We partnered with OHSU researcher and emergency medicine physician Dr. Benjamin Sun to identify opioid prescribing patterns in Washington State and understand how opioid prescribing responds to policy interventions.
- Impact of Hospital "Best Practice" Mandates on Prescription Opioid Dispensing After an Emergency Department Visit. Academic Emerg Med, 2017
- Does Prescription Opioid Shopping Increase Overdose Rates in Medicaid Beneficiaries? Annals of Emerg Med, 2017
- Effect of Automated Prescription Drug Monitoring Program Queries on Emergency Department Opioid Prescribing. Annals of Emerg Med, 2018
Value-based payment for joint replacement
Comprehensive Care for Joint Replacement (CJR)—Medicare's first mandatory bundled payment program—reflects a national move towards value-based payment. Led by Dr. Hyunjee Kim, our team is examining whether CJR affects well-documented racial disparities in joint replacement care.
Evaluation of Oregon’s Value-based Payment for Coordinated Care Organizations
In 2019, the State of Oregon developed a Value-based Payment (VBP) Roadmap for Coordinated Care Organizations (CCOs) as a foundational element of the CCO 2.0 contract cycle (2020-2024).
In 2020, the Roadmap introduced requirements to be implemented over the course of the new contract cycle. These requirements include the development of new VBP models in specific care areas and targets for the adoption of VBP arrangements with provider organizations over time. CCOs’ readiness to achieve these requirements was a consideration in the CCO 2.0 award cycle.
Evaluation of Oregon's 1115 Medicaid Waiver for the Oregon Health Authority
In 2017, Oregon renewed its Section 1115 Medicaid demonstration waiver with the federal Centers for Medicare & Medicaid Services (CMS), continuing its work to leverage its coordinated care organization model to produce better health outcomes at sustainable costs. CHSE continues in its role as the independent external evaluator for the Oregon Health Authority (OHA) for the new 2017-2022 waiver after providing the summative assessment for the 2012 waiver.
Behavioral Health Workforce Evaluation
Oregonians report one of the highest rates of unmet need for mental health treatment in the nation. House Bill 2086 was passed in 2021 to address behavioral health workforce shortages and access to care, particularly among people of color, tribal communities and other historically marginalized groups.
This report was prepared in partnership with the Oregon Health Authority and is intended to provide recommendations for achieving a living wage for behavioral health workers and providing more equitable wages between physical health care workers and behavioral health care workers.
Behavioral Health Integration
States are asking a variety of questions about the best ways to integrate behavioral and physical health care in Medicaid, including how to finance these services. This brief offers a taxonomy for the financing of integrated mental health in Medicaid programs.
Washington's Medicaid Transformation Program Section 1115 Waiver Evaluation
CHSE serves as the independent external evaluator for the Washington Health Care Authority's Medicaid waiver, known as the Medicaid Transformation Project (MTP). In partnership with qualitative investigators at the OHSU Department of Family Medicine, CHSE is assessing progress on MTP's five initiatives.
- Read the December 2020 midpoint report
Social Determinants of Health
Challenges with food insecurity, housing, non-medical transportation and other social needs impact members' health and well-being. State Medicaid programs are increasingly seeking ways to advance health equity and address these social determinants of health.
McConnell KJ, Kaufman MR, Grunditz JI, Bellanca H, Risser A, Renfro S. Addressing Foster Care Placement for Young Children through Integrated Maternity Care. Health Affairs [In Press.]
Lindner S, Marino M, O'Malley J, Angier H, Bailey SR, Hoopes M, Springer R, McConnell KJ, DeVoe J, Huguet N. Health Care Expenditures among Adults with Diabetes after Oregon's Medicaid Expansion. Diabetes Care. [In Press.]
Kim H, Grunditz J, Meath T, Quinones A, Ibrahim S, McConnell KJ. Accuracy of hospital discharge codes in Medicare claims for knee and hip replacement patients. Medical Care, Forthcoming.
George RM, Gunn R, Wiggins N, Rowland R, Davis MM, Maes K, Kuzma A, McConnell KJ. Early Lessons and Strategies from Statewide Efforts to Integrate Community Health Workers into Medicaid. Journal of Health Care for the Poor and Underserved. [In Press.]
Lind B, Gu Y, McCarty D, Baker R, McConnell KJ. Predictors of Substance Use Treatment Initiation and Engagement among Adult and Adolescent Medicaid Recipients. Substance Abuse [In Press.]
McConnell KJ, Charlesworth CJ, Zhu J, Meath THA, George RM, Davis MM, Saha SS, Kim H. Access to primary, mental health, and specialty care: a comparison of Medicaid and commercially insured populations in Oregon. Journal of General Internal Medicine, 2020; 35(1): 247-254. PMID: 31659659.
McConnell KJ, Charlesworth CJ, Zhu J, Meath THA, George RM, Davis MM, Saha S, Kim H. Access to Primary, Mental Health, and Specialty Care: A Comparison of Medicaid and Commercial Insured Populations in Oregon. Journal of General Internal Medicine. 35(1), 247-254. 2019. PMID: 31659659.
Edwards ST, Hooker ER, Brienza R, O’Brien B, Kim H, Gilman S, Harada N, Gelberg L, Shull S, Niederhausen M, , King S, Hulen E, Singh MK, Tuepker A. Association of a multisite interprofessional education initiative with quality of primary care. JAMA Network Open, 2019; 2(11):e1915943. PMID: 31747038.
Kim H, Meath T, Dobbertin K, Quiñones A, Ibrahim S, McConnell KJ. Association of the mandatory Medicare bundled payment with outcomes in hospitals with disadvantaged patient populations. JAMA Network Open, 2019; 2(11):e1914696. PMID: 31693127.
Meisel ZF, Lupulescu-Mann N, Charlesworth CJ, Kim H, Sun BC. Conversion to persistent or high-risk opioid use after a new prescription from the emergency department: evidence from Washington Medicaid beneficiaries. Annals of Emergency Medicine, 2019; 74(5): 611-621. PMID: 31229392.
Wu B, Jung K, Kim H, Polsky D. Entry regulation and the effect of public reporting: evidence from Home Health Compare. Health Economics, 2019; 28(4): 492-516. PMID: 30689246.
Obadan-Udoh E, Lupulescu-Mann N, Charlesworth C, Muench U, Jura M, Kim H, Schwarz E, Mertz E, Sun B. Opioid prescribing patterns after dental visits among beneficiaries of Medicaid in Washington State in 2014 and 2015. Journal of the American Dental Association, 2019; 150(4): 259-268.el. PMID: 30922457.
Edwards S, Kim H, Shull S, Hooker E, Niederhausen M, Tuepker A. Quality of outpatient care with internal medicine residents vs attending physicians in Veterans Affairs primary care clinics. JAMA Internal Medicine, 2019; 179(5): 711-713. PMID: 30933246.
Kim H, Grunditz J, Meath T, Quinones A, Ibrahim S, McConnell KJ. Level of reconciliation payments by safety-net hospital status under the first year of the Comprehensive Care for Joint Replacement Program. JAMA Surgery, 2019; 154(2):178-179. PMID: 30304467.
Kim H, Charlesworth C, McConnell KJ, Valentine J, Grabowski D. Comparing care for dual-eligibles across coverage models: empirical evidence from Oregon. Medical Care Research & Review, 2019; 76(5): 661-677. PMID: 29139330.
McConnell KJ, Lindner S. Estimating Treatment Effects with Machine Learning. Health Services Research. 54(6) 1273-1282. 2019. PMID: 31602641.
Kushner J, McConnell KJ. Addressing Social Determinants of Health through Medicaid: Lessons from Oregon. Journal of Health Politics, Policy and Law 44(6):919-935. 2019. PMID: 31408877
McConnell KJ. Investing in Primary Care and Dismantling Fee-For-Service. Milbank Quarterly 97(3): 636-640. 2019.
Lindner S, McConnell KJ. Difference-in-difference and Matching on Outcomes: A Tale of Two Unobservables. Health Services and Outcomes Research Methodology 19(2-3): 127-144. 2019.
Kim H, Meath T, Grunditz J, Quinones A, Ibrahim S, McConnell KJ. Characteristics of hospitals exiting the newly voluntary Comprehensive Care for Joint Replacement program. JAMA Internal Medicine, 2018; 178(12): 1715-1717. PMID: 30422206.
Keast S, Kim H, Deyo R, Middleton L, McConnell KJ, Zhang K, Ahmed S, Nesser N, Hartung D. Effects of a prior authorization policy for extended-release/long-acting opioids on utilization on outcomes in a state Medicaid program. Addiction, 2018; 113: 1651-1660. PMID: 29679440.
Hartung D, Kim H, Ahmed S, Middleton L, Keast S, Deyo R, McConnell KJ. Effect of a high dosage opioid prior authorization policy on prescription opioid use, misuse, and overdose outcomes. Substance Abuse, 2018; 39(2): 239-246. PMID: 29016245.
Meckler G, Sheridan D, Charlesworth C, Lupulescu-Mann N, Kim H, Sun BC. Opioid prescribing practices for pediatric headache. Journal of Pediatrics, 2018; pii: S0022-3476(18): 31252-6. PMID: 30274923.
Sun BC, Lupulescu-Mann N, Charlesworth C, Kim H, Hartung D, Deyo A, McConnell KJ. Variations in prescription drug monitoring program use by prescriber specialty. Journal of Substance Abuse Treatment, 2018; 94:35-40. PMID: 30243415.
McConnell KJ, Charlesworth C, Meath T, George R, Kim H. Oregon’s emphasis on equity for black and American Indian Medicaid enrollees shows signs of early success. Health Affairs, 2018; 37(3): 386-393. PMID: 29505371.
Choi Y, Kim Y, Lee J, Kim H, Kim T, Kim S. Bilinear, multidimensional cultural orientations and indigenous family process among Korean immigrant mothers and fathers. Asian American Journal of Psychology, 2018; 9(2): 127-139. PMID: 30344895.
Sun BC, Charlesworth C, Young J, Lupulescu-Mann N, Kim H, Hartung D, Deyo R, McConnell KJ. Effect of automated prescription monitoring program queries on emergency opioid prescribing. Annals of Emergency Medicine, 2018; 71(3): 337-347.e6. PMID: 29248333.
Sun BC, Lupulescu-Mann N, Charlesworth C, Kim H, Hartung D, Deyo R, McConnell KJ. Does prescription opioid shopping increase overdose rates in Medicaid beneficiaries? Annals of Emergency Medicine, 2018; 71(6): 679-687.e3. PMID: 29174833.
Chang AM, Cohen D, Lin A, Augustine J, Handel D, Howell E, Kim H, Pines J, Schuur J, McConnell KJ, Sun BC. Hospital strategies for reducing emergency department crowding: a mixed-methods study. Annals of Emergency Medicine, 2018; 71(4): 497-505.e4. PMID: 28844764.
Broffman L, Spurlock M, Dulacki K, Campbell A, Rodriguez F, Wright B, McConnell KJ, Warne D, Davis MM. Understanding Treatment Gaps for Mental Health, Alcohol, and Drug Use in Rural and Reservation Areas. The Journal of Rural Health 331(1):71-81. 2017.
Chang AM, Laurie A, Prewitt L, Fu R, McConnell KJ, Sun BC. Associations of Emergency Department Length-of-Stay with Publicly Reported Quality-of-Care Measures. Academic Emergency Medicine. 24(2):246-250. 2017. PMID: 27640877.
Hartung D, Ahmed S, Middleton L, Otterloo J, Zhang K, Keast S, Kim H, Johnston K, Deyo R. Using prescription monitoring program data to characterize out-of-pocket payments for opioid prescriptions in a state Medicaid program. Pharmacoepidemiology and Drug Safety, 2017; 26(9): 1053-1060. PMID: 28722211.
Sun BC, Lupulescu-Mann N, Charlesworth C, Kim H, Hartung D, Deyo R, McConnell KJ. Impact of hospital “best practice” mandates on prescription opioid dispensing after an emergency visit. Academic Emergency Medicine, 2017; 24(8): 905-913. PMID: 28544288.
Huang S & Kim H. Home health chains and practice patterns: evidence of 2008 Medicare reimbursement revision. Population Health Management, 2017; 20(5): 374-382. PMID: 28437195.
Kim H & Norton EC. How home health agency’s ownership affects practice patterns. Fiscal Studies, 2017; 38(3): 469-493.
Kim H, Wu B, Jung K. Competition and home health agencies’ gaming behavior in the United States. Home Health Care Management & Practice, 2017; 29(2): 63-69.
Kim H, McConnell KJ, Sun B. Comparing emergency department use among Medicaid and commercial patients using All Payer All Claims data. Population Health Management, 2017; 20(4):271-277. PMID: 28075692.
Huguet N, Angrier H, Marino M, McConnell KJ, Hoopes M, O'Malley J, Likumahuwa-Ackman S, Holderness H, Raynor L, DeVoe JE. Protocol for the Analysis of a Natural Experiment on the Impact of the Affordable Care Act on Diabetes Care in Community Health Centers. Implementation Science. 10;12(1):14. 2017. PMID: 28183354.
McCarty D, Rieckmann T, Baker R, McConnell KJ. Does 42 CFR part 2 inhibit coordination and integration of care? A qualitative analysis. Psychiatric Services. 68, 245-249. 2017.
McConnell KJ, Renfro S, Wallace N, Cohen DJ, Lindrooth RC, Chernew M. Oregon's Medicaid Reform and Transition to Global Budgets were Associated with Reductions in Expenditures. Health Affairs. 36(3) 451-459. 2017.
Charlesworth CJ, Meath T, Schwartz A, McConnell KJ. Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations. JAMA Intern Med. 2016. 176(7):998-1004. doi:10.1001/jamainternmed.2016.2086.
Cohen DJ, Balasubramanian BA, Gorden L, Marino M, Ono S, Solberg LI, Crabtree BF, Stange KC, Davis M, Miller WL, Damschroder LJ, McConnell KJ, Creswell J. A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol. Implementation Science 11(1):86. 2016. PMID: 27358078.
Davis MM, Spurlock M, Dulacki K, Meath T, Li H, McCarty D, Warne D, Wright B, McConnell KJ. The South Dakota Health Survey: Assessing Disparities in Behavioral Health Services in Rural and Reservation Areas. The Journal of Rural Health 32(3): 287-302. 2016. PMID:26515583.
Graven P, Chan BC, Meath T, Mendelson A, Kim H, McConnell KJ. Preventable Acute Care Spending for High-Cost Patients Across Payer Types. Journal of Health Care Finance 42(3): 1-22. 2016.
Ibrahim SA, Kim H, McConnell KJ. The CMS Comprehensive Care Model and Racial Disparity in Joint Replacement. JAMA 316(12) 1258-9. 2016. PMID: 27653166.
Kim H, Jacob L, Hartung D, McCarty D, McConnell KJ. The Concentration of Opioid Prescriptions by Physicians and Patients in the Oregon Medicaid Program. Psychiatric Services 67(4):397-40. 2016.
Lindner, Stephan. How Do Unemployment Insurance Benefits Affect the Decision to Apply for Social Security Disability Insurance? Journal of Human Resources 51(1): 62-94. 2016.
Marino M, Bailey SR, Gold R, Hoopes MJ, O'Malley JP, Huguet N, Heintzman J, Gallia C, McConnell KJ, DeVoe JE. Receipt of Preventive Services after Oregon's Randomized Medicaid Experiment. American Journal of Preventive Medicine 50(2):161-70. 2016. PMID: 26497264.
McConnell KJ. Oregon's Medicaid Coordinated Care Organizations JAMA. 315(9):869-870. 2016.
McConnell KJ, Lindrooth RC, Wholey DR, Maddox TM, Bloom N. Modern Management Practices and Hospital Admissions. Health Economics 25(4)470-485.2016. PMID: 25712429.
Mendelson A, Goldberg B, McConnell KJ. New Rules for Medicaid Managed Care –Do They Undermine Payment Reform? Healthcare: The Journal of Delivery Science and Innovation 4(4): 274-276. 2016.
Newgard CD, Yang Z, Nishijima D, McConnell KJ, Trent S. Holmes JF, Daya M, Mann NC, Hsia R, Rea T, Wang NE, Delgado MK. The Cost Effectiveness of Field Trauma Triage Among Injured Adults Served by Emergency Medical Services. Journal of the American College of Surgeons. 222(6): 1125–1137. 2016. PMID: 27178369.
Rodriguez MI, Edelman A, Swartz J, McConnell KJ. Pharmacists begin prescribing hormonal contraception in Oregon: Baseline knowledge and interest in provision. Journal of the American Pharmacists Association 56(5) 521-6. 2016. PMID: 27594105.
Sun B, Laurie A, Prewitt L, Fu R, Chang AM, Augustine J, Reese C, McConnell KJ. Risk Adjusted Variation for Publicly Reported Emergency Department Timeliness Measures. Annals of Emergency Medicine; 67(4): 509-516. 2016. PMID: 26116220 PMID: PMC4690810.
Chang AM, Cohen D, McCarty D, Rieckmann T, McConnell KJ. Oregon's Medicaid Transformation – Early Observations on Variations in Organizational Structure and Strategy. Journal of Health Politics, Policy and Law 40(1):257-64. 2015. PMCID: PMC4352375.
Dorr DA, McConnell KJ, Williams MPJ, Gray KA, Wagner J, Fagnan LJ, Malcolm E. Transforming Outcomes for Medical home Evaluation and Redesign: Pragmatic development of a cluster randomized controlled trial. Implementation Science 10:13. 2015. PMID: 25609501.
DeVoe JE, Marino M, Gold R, Hoopes MJ, Cowburn S, O'Malley JP, Heintzman J, Gallia C, McConnell KJ, Nelson CA, Huguet N, Bailey SR. Community Health Center Use After Oregon's Randomized Medicaid Experiment. Annals of Family Medicine. 13(4): 312-20. 2015.
Kim H & Norton EC. Effects of the ten percent cap in Medicare home health care on treatment intensity and patient discharge status. Health Services Research, 2015. DOI:10.1111/1475-6773.12290 PMID: 25732007.
Kim H & Norton EC. Practice patterns among entrants and incumbents in the home health market after the Prospective Payment System was implemented. Health Economics, 2015; 24(S1): 118-131. DOI: 10.1002/hec.3147.
Rodriguez MI, Darney B, Linz L, Elman E, Caughey AB, McConnell KJ. Examining quality of contraceptive services for adolescents in Oregon's family planning program. Contraception. 91(4):328-35. 2015. PMID: 25545334.
Sun BC, Chi DL, Schwarz E, Milgrom P, Yagapen A, Malveau S, Chen Z, Chan B, Danner S, Owen E, Morton V, Lowe RA. Emergency Department Visits for Nontraumatic Dental Problems: A Mixed-Methods Study. American Journal of Public Health, 2015, 105(5): 947-955.
Choo EK, Zaller ND, Benz M, Warren O, Rising K, McConnell KJ. The Impact of State Policy on Adolescent Marijuana Use. Journal of Adolescent Health. 55(2): 160-6. 2014. PMID: 24742758.
Englander H, Michaels L, Chan B, Kansagara D. The Care Transitions Innovation (C-TraIn) for Socioeconomically Disadvantaged Adults: Results of a Cluster Randomized Controlled Trial. Journal of General Internal Medicine. 29(11): 1460-1467. 2014.
Fried B, Pintor, JK, Graven P, Blewett LA. (2014). Implementing Federal Health Reform in the States: Who Is Included and Excluded and What Are Their Characteristics?. Health Services Research, 49: 2062–2085. doi: 10.1111/1475-6773.12232.
McConnell KJ, Chang AM, Cohen D., Kautz G, McCarty D, McFarland B, Wallace N, Wright B, Chernew M, Smith JA. Oregon's Medicaid Transformation: An Innovative Approach To Holding A Health System Accountable For Spending Growth. Health Care: The Journal of Delivery Science and Innovation. 2(3): 163–167. 2014. PMCID: PMC4273859.
McConnell KJ, Chang AM, Maddox TM, Wholey DR, Lindrooth RC. An Exploration of Management Practices in Hospitals. Health Care: The Journal of Delivery Science and Innovation. 2: 121-129. 2014.
Gustafson DH, Quanbeck AR, Ford JH, Pulvermacher A, French MT, McConnell KJ, Batalden P, Hoffman K, McCarty D. Which Elements of Improvement Collaboratives Are Most Effective? A Cluster-Randomized Trial. Addiction 108(6): 1145-57. 2013. PMCID: PMC3651751.
Hartung DM, Middleton L, McFarland BF, Beasley D, Meeker A, McDonough M., Haxby DG, McConnell KJ. Validity of Health Administrative Data to Identify Off-label Second Generation Antipsychotic use in a Medicaid Population. Psychiatric Services. 64(12) 1236-42. 2013. PMID: 23999754.
McConnell KJ, Lindrooth RC, Wholey DR, Maddox TM, Bloom N. Management Practices and the Quality of Care in Cardiac Units. JAMA Internal Medicine. 173(8): 684-92. 2013. PMID: 23552986.
McConnell KJ. The Effect of Parity on Expenditures for Individuals with Severe Mental Illness. Health Services Research 48(5) 1634-1652. 2013. PMCID: PMC3720714.
Newgard CD, Staudenmayer K, Hsia YR, Mann NC, Bulger EM, Holmes JF, Fleischman RJ, Gorman K, Haukoos JS, McConnell KJ. The Cost of Over-triage: More Than One-Third of Low-Risk Injured Patients Were Taken to Major Trauma Centers. Health Affairs. 32(9): 1591-99. 2013. PMCID: PMC4044817.
Snowden JJ, Darney BG, Cheng YW, McConnell KJ, Caughey AB. Systems Factors in Obstetric Care: The Role of Daily Obstetric Volume. Journal of Obstetrics and Gynecology. 122(4):851-857. 2013. PMID 24084544.
Wallace NT, McConnell KJ. Impact of Comprehensive Insurance Parity on Follow-Up Care after Psychiatric Inpatient Treatment in Oregon. Psychiatric Services 64(10): 961-966. 2013. PMID 23771583.
Reports and working papers
Lindner, Stephan, Regan Considine, Margaret Spurlock, Melinda Davis, and Ruth Rowland: "The Impact of the Affordable Care Act on People with Disabilities: A Summer 2015 Status Report." National Council on Disability: Washington, DC, in press.
Oregon Health Authority and Center for Health Systems Effectiveness (2015). Impacts of the Affordable Care Act on Health Insurance Coverage in Oregon: County Results/Statewide Update.
Office for Oregon Health Policy Research, Center for Health Systems Effectiveness and Oregon Healthcare Workforce Institute (2014). The Projected Demand for Physicians, Nurse Practitioners, and Physician Assistants in Oregon: 2013-2020. Report prepared for Oregon Health Authority.
Abraham JM, Feldman R, Graven, Peter. How Will the Affordable Care Act Change Employers’ Incentives to Offer Insurance? (January 01, 2014). US Census Bureau Center for Economic Studies Paper No. CES-WP- 14-02.
Abraham JM, Feldman R, Graven, Peter. New Evidence on Employer Price‐Sensitivity of Offering Health Insurance (January 01, 2014). US Census Bureau Center for Economic Studies Paper No. CES-WP- 14-01.
The State Health Access Data Assistance Center, Center for Health Systems Effectiveness, and Manatt Health Solutions (2013). Estimated Financial Effects of Expanding Oregon’s Medicaid Program under the Affordable Care Act (2014-2020). Report prepared for Oregon Health Authority.