1. Oregon's Coordinated Care Organizations: First Year Expenditure and Utilization Authors: Neal Wallace, PhD, Peter Geissert, MPH 1, and K. John McConnell, Ph.D. 2 1. Portland State University 2. Oregon Health & Science University As a part of its continuing health system transformation activities, the state of Oregon has implemented Coordinated Care Organizations (CCOs) to provide care for Oregon’s Medicaid beneficiaries. Like Accountable Care Organizations (ACOs), CCOs are community-based networks of providers, community members, and insurers who bear financial risk for a portion of the Medicaid population. Each CCO will receive a global budget and will be responsible for coordinating physical, behavioral and dental health care for its members while being held accountable for maintaining or improving population health. Specific characteristics of Oregon’s CCOs will vary, since they are intended to evolve from individual communities who best know their own needs. CCO implementation began in July 2012. There are currently 16 CCOs covering all geographic regions of the state providing care to over 90% of Oregon’s Medicaid enrollees. Estimate changes in expenditures and utilization related to implementation of Oregon’s Medicaid Coordinated Care Organizations overall and by CCO type. CCO effects were estimated as the difference-in-difference of continuously enrolled adult OHP members and propensity score matched commercially insured Oregonians. Subject matching was based on presence during the study period of a diagnosis for eight chronic conditions (asthma, COPD, diabetes, CHF, schizophrenia/bipolar disorder, dementia, hypertension, hyperlipidemia) along with age, gender and geographic location. Study data were derived from the Oregon All Payers All Claims database (APAC), reflecting one year pre- and post- CCO implementation (July 2011 - June 2012 & October 2012 -September 2013). CCO “Level” reflects community advisory committee and CCO board engagement, as well as span of representation of CCO organizational members, Level 1 reflects highest engagement and representation. A two-part model with propensity score weighting and adjustments for temporal price changes was employed to generate estimates of the rate of change in probability of use, cost per user and cost per subject in total and for salient service categories. Background Research Objective Study Design Study Population Primary care expenses increased while specialty care decreased No other changes in $/person were statistically significant Pharmacy use down, $/user up, but no net effect on expenses Some reductions in overall probability of service use Level 1 &2 CCOs appear to have similar effects Level 3 CCOs appear to be targeting service use more Enhanced primary care services and reduced specialty care appear to be consistent with expectations of the program and with findings for concurrent implementation of Patient Centered Primary Care Homes (PCPCH) Other expected changes, such as reduced ED and IP, may be emerging but are not yet evident through the first year CCOs with organizational features most aligned with program intent appeared to effect the most change overall Different strategic approaches may be occurring across CCO types Principal Findings Policy Implications CCOs appear to be effective in shifting patterns of treatment at least in respect to use of ambulatory care CCOs with organizational features most aligned with program intent appear to be having the most impact on overall expenses Individual CCO impacts may vary appreciably Conclusions Table 1: Study Sample Characteristics Table 2: Pre-Post CCO Utilization and Expenditure Change A random sample of 4,241 continuously enrolled adult OHP members and 67,511 propensity score matched commercially insured Oregonians. Sample reflects individuals sampled and surveyed in an additional branch of this research. CCO personnel and organizational members were interviewed to develop assessment of CCO organizational characteristics. Results Limitations Results reflect only adults and thus do not capture effects for children or true overall impact of CCOs Results reflect short- term (one year) impacts of CCOs only Commercially insured comparison group may differ on unobserved characteristics that could bias results Study may not have sufficient power to capture all individual service level effects Level 3 CCO subjects underrepresented Contact Information Neal Wallace, Ph.D., Professor of Public Administration Mark O. Hatfield School of Government, Portland State University nwallace@pdx.edu CCOControl (%) N = 4241 N = 67511 Age 18-255.2 26-3519 36-4520.2 46-5533.7 56-6421.6 64+< 1 Female58.4 Asthma11.7 Bipolar/Schizophrenia7.2 Cerebrovascular disease4.6 Congestive Heart Failure1.8 COPD11.7 Dementia< 1 Diabetes18.1 Chronic Kidney disease1.3 $ per PersonAll Level 1 Level 2 Level 3 (% Rate of Change)CCOs Service CategoryN=4,241 N=1,603 N=1,895 N=565 Total-0.043 -0.059-0.055 0.058 Primary care services0.073*0.112*0.083*-0.145 Specialty care services-0.188*-0.22*-0.221*0.083 MH services0.100 0.0420.133 0.088 Pharmacy0.029 0.0740.017 -0.014 ED-0.092 -0.197-0.062 -0.089 Inpatient-0.161 0.116 -0.203 -0.219 $ per User (% Rate of Change) Total-0.026 -0.032-0.042 0.051 Primary care services0.063*0.108*0.028 -0.031 Specialty care services-0.043 -0.061-0.077 0.198 MH services0.046 0.113-0.021 0.269 Pharmacy0.099*0.1640.079 0.018 ED-0.029 -0.2120.005 0.129 Inpatient-0.232 -0.162 -0.002 -0.336 Rate of Change in Probability of Use Total-0.014*-0.022*-0.011 0.005 Primary care services0.010 0.0040.049*-0.104* Specialty care services-0.131*-0.143*-0.13*-0.104* MH services0.053 -0.070.15 -0.18 Pharmacy-0.063*-0.08*-0.056*-0.029 ED-0.064 0.012-0.067 -0.213* Inpatient0.071 0.274 -0.198 0.116 * = p<.05