As all eyes turn to Oregon, OHSU poised to study impact of reform efforts

Dr. McConnellNIH grant and private gift increase capacity for OHSU to lead in ‘delivery system science’

Oregon is embarking on ambitious health care reform with the formation of Coordinated Care Organizations (CCOs), and the eyes of the nation will be watching as the experiment to transform care for Medicaid patients unfolds (see background articles below). And now, John McConnell, Ph.D., director of OHSU’s Center for Health Systems Effectiveness (CHSE), and a team of researchers are poised to strengthen OHSU’s capacity for what President Joe Robertson calls “delivery system science.”

On Nov. 26, OHSU announced the receipt of a $2.26 million grant from the National Institutes of Health (NIH) and a $2.26 million gift from Phil and Barbara Silver that will combine to strengthen OHSU’s capacity to analyze health reform efforts and contribute to bending the cost curve down.

“There has been a great deal of interest nationally on how Oregon’s CCO experiment is going to work,” said Dr. McConnell, associate professor of emergency medicine and lead researcher. “This grant will allow us to take a deep dive into the hows, whys, and wheres of CCOs – which CCOs are high performers, how savings are accrued, and what the effects are on quality.”

Phil and Barbara SilverThe gift from Phil and Barbara Silver will support Dr. McConnell’s work and strengthen the CHSE. “We are particularly excited about expanding the health economics capacity at OHSU – we think our work here will provide critical information for the State and the rest of the country,” said Dr. McConnell.

What appeals to me about John McConnell’s work is that he is applying rigorous, data-driven analysis to a subject that tends to get mired in politics,” said Phil Silver.

“One of the best hopes for improving outcomes at lower cost is to study the health care system analytically and apply what we learn. In short, process engineering for the health care industry,” said President Robertson. “That may not sound glamorous but the impact will be profound. Between the excellent work of John McConnell as well as the application of evidence to both practice and policy, OHSU has the resources to make a difference in this debate.”

Dr. Robertson speaksThe implementation of CCOs provides a unique opportunity to assess key economic questions faced by public and private payers across all states. In this era of health care reform and quests to achieve the Triple Aim, the route to cost savings is one critical question. Another – unique to CCOs which will operate under a global budget – is determining the effect of bundling payments for behavioral, physical and dental health care.

Over the next four years, Dr. McConnell and the CHSE team of researchers, subject matter experts and advisors mean to answer these questions through the following specific aims, outlined in their NIH proposal:

  • Determine how a large exogenous decrease in spending in Oregon affects utilization, payment rates, and the composition of provider networks.
  • Determine the impact of exogenous decreases in spending in Oregon on the quality of care.
  • Determine the effect of bundling payments for behavioral and physical health care on the integration of care between behavioral and physical health care providers
  • Complete a qualitative assessment to understand the key governance, organizational, and contextual variables affecting the transition to a restructured Medicaid program.

The Silver gift will enhance these goals and allow for additional research, such as assessing variations between Portland-based CCOs and smaller rural CCOs, exploring whether the CCO model is viable for commercially insured populations, and informing key audiences – legislators, business leaders, scholars and the media, for example – of the study’s findings.

As Dr. McConnell wrote on OHSU’s 96,000 Square Miles blog, “when it comes to knowing what works in the health care system, we are in the dark ages.” FPP/Clinician Commons will provide updates on this study as they become available.


Additional Reading


Pictured: (top) John McConnell, Ph.D., describes his vision for an economic study of Oregon's Coordinated Care Organizations; (middle) Phil and Barbara Silver; (bottom) President Joe Robertson speaks to a group of OHSU faculty, staff and friends at the Nov. 26 announcement

(object placeholder)