CareOregon
I want to develop an Annotated Bibliography for the CareOregon Triple Aim case study.
1.Full bibliographic citation :Project Title:
Achieving the Triple Aim in Medicaid: Evaluating the Access,
Quality, Health and Cost
Impacts of Coordinated Care Organizations in Oregon.Grant Period:
July 1, 2012 – December 31, 2014
2.Authors background :Team Members: Bill Wright, PhD Providence
Center for Outcome Research & Education
Neal Wallace, PhD Portland State University
3.purpose of the work:Aim 1 of the study was to evaluate the
impact of CCOs on health care access and quality, as
well as patient engagement, health behaviors, and health outcomes
over time. Using existing
survey data from the Oregon Health Insurance Experiment (OHIE), we
compared the results for
individuals who enrolled in a CCO against those who did not.
Aim 2 was to evaluate the effects of CCOs on health care
utilization patterns, per-member
costs, and per-user costs over time. We mapped claims data from the
Medicaid components of
Oregon’s new All Payer All Claims (APAC) database to our survey
panel, calculated utilization
and costs for panel members before and after CCO implementation,
and assessed changes in
expenditure totals and patterns.
Aim 3 was to document the mechanisms of transformation, and
assess CCO’s defining
characteristics, similarities and differences. We used document
review and qualitative interviews
to assess each CCO along four key structural domains – governance,
organization, finance, and
operations. Our goal was to tie CCO characteristics to survey and
administrative performance
data in order to understand the key CCO design elements that lead
to the best outcomes.
4.scope of the work :They are regionally
based: CCOs are community-based networks of providers, community
programs, and insurers who
bear financial risk for their local Medicaid population. They are
also integrated: CCOs receive a single
global budget to pay for the physical, mental, and dental care of
their assigned members.
5.Main argument:Research Question 1: What is the impact of
Oregon’s CCO model on health care access, health
care quality, health care utilization, preventive care, care
coordination, and health outcomes?
Research Question 2: What are the impacts of Oregon’s CCO model
on health care utilization
and costs?
Research Question 3: What are the structural and functional
characteristics of CCOs; how do
they differ from previous arrangements; and, how do they vary among
CCOs?
Research Question 4: What does integration of qualitative and
survey data tell us about health
system transformation?
6.Audience:public
7.Methodology:Qualitative study- survey method, longitudinal
8.Source:DRAFT PAPERS:
“Oregon’s CCO Experiment: Promising Early Signs of Change at the
Member Level.” Manuscript
prepared for submission in March 2015.
“Defining Accountable Care: Lessons from the Development of
Oregon’s Coordinated Care
Organizations.” Manuscript under development for submission in
summer 2015.
9.Limitations :Limitations to our qualitative data and analyses
include substantial
differences in the quantity and quality of information in both the
CCO applications and Transformation
Plans.The utility of the information available in the
applications and Transformation Plans was also limited by their
high-level focus on future goals, with
limited information about past and current activities to implement
specific structural, functional, and
operational strategies.
10.Barriers:1.Refo Exhaustion.2.CCOs Spread Wider than
Expected.3.Point-in-Time Research Protocols.4.Timing: The follow-up
survey was fielded quite early in CCO implementation, so some of
the
envisioned transformation has not yet fully happened. We knew that
transformation would take time,
but it was hard to predict exactly what would and would not have
happened by the time we fielded the
survey. We are happy to report initial findings and eager to
conduct a follow-up study in the future.
11.personal conclusion:The project has provided early evidence
of the potential benefits of a fundamental re-orientation of
the health care delivery system to achieve the Triple Aim goals of
better health, better care and lower
cost. While the project did not create a new model for delivering
service, it does document how,
exactly, a statewide health system may be re-designed to provide
greater integration and coordination
of services, and how such changes can positively affect access,
quality and costs of care.
CareOregon I want to develop an Annotated Bibliography for the CareOregon Triple Aim case study.
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