Question

CareOregon

I want to develop an Annotated Bibliography for the CareOregon Triple Aim case study.

Answer 1

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.