Midpoint Evaluation of Oregon's Medicaid Section 1115 Demonstration: Mid-2012 through Mid-2014
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Key Findings
Key Findings:
- The formative evaluation indicated that the Oregon Health Authority (OHA) succeeded at establishing the program’s global payment model and data-driven approach to monitoring coordinated care organization (CCO) performance and incentive payments. Nevertheless, OHA still needed to address how it braided together finances from disparate systems to avoid ongoing payment silos.
- The CCOs made good progress in supporting the spread of patient-centered primary care homes and promoting the use of electronic health records. At the time of the study, CCOs were still in the early stages of implementing alternative payment methods for their providers and they were seeking support from OHA to help them develop the necessary infrastructure to implement new payment models, particularly for small provider practices.
- The summative evaluation indicated the introduction of the CCOs were associated with very few changes in state-level outcomes during the program’s first 21 months of operation. The lack of results may reflect the early stages of activities that OHA and the CCOs are pursuing. Conversely, the results do not suggest widespread negative results as a consequence of introducing the CCO model.
- Even though few state-level demonstration effects were detected, our results suggest that some effects may be occurring within specific subgroups of enrollees. For example, inpatient admissions declined among members of the three CCOs in the most advanced stages of their transformation activities relative to the three CCOs in the earliest stages of their transformation activities, suggesting that the level of transformation at the CCO level factors into the level of hospital utilization. We also found improved parity in some outcome measures for some subgroups, such as improvements in potentially preventable hospital admissions for chronic conditions among black enrollees.
The focal point of Oregon’s Medicaid 1115 demonstration is the implementation of coordinated care organizations (CCOs), which are the single point of accountability for health care access, quality, and outcomes of Medicaid beneficiaries. CCOs must institute a governance structure that includes the managed care entities that provide physical, behavioral, or oral health services and individual providers or community health centers. CCOs must also convene a community advisory council (CAC) that includes representatives from the community as well as representatives from local government entities, but with consumers making up the majority of the CAC. CCOs are responsible for integrating all services, including physical, behavioral, and oral health services, under a global budget based on a per-member, per-month payment structure. They must also have in place transformation plans that describe their activities relating to eight specific elements of Medicaid delivery system transformation.
This report summarizes the results of the midpoint evaluation of Oregon’s demonstration and the introduction of CCOs and covers the program since its inception in mid-2012 through mid-2014. The evaluation was conducted by Mathematica Policy Research under contract with the Oregon Health Authority (OHA). The evaluation includes both formative and summative components. The formative component is based on documentary evidence, key informant interviews, site visits, and a self-administered survey of CCOs that assessed progress with their transformation activities. The summative component is based on a pre/post assessment of outcome measures that could be constructed with encounter data. Given the early nature of the evaluation, the results presented this report should be considered preliminary and subject to change as the demonstration evolves.
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