There is broad agreement that the United States must slow rising health care costs, yet relatively little consensus about how best achieve it. This proposal aims to evaluate a policy experiment in the Oregon Medicaid program, using the Colorado Medicaid program as a control state. Colorado and Oregon have developed parallel programs that reflect the national movement toward accountable care and primary care medical homes. However, Oregon differs from Colorado in two significant ways. First, savings in Oregon's CCOs are enforced with a transition to a global budget that includes a large (11%) reduction in spending in their first year. Second, whereas Colorado continues fee-for-service (FFS) payments for specialists and carved-out behavioral health care, Oregon's program integrates funding and payment for behavioral and physical health care, including funds that have traditionally been """"""""carved out"""""""" for mental health and addiction treatment. CCOs have flexibility in how these dollars are spent. We will assess two key economic questions that are relevant to public and private payers across all states. First, faced with a large, exogenous decrease in funding, how are savings accomplished? Is it primarily through reductions in payment rates, or is it through an incentive to integrate delivery to realize efficient utilization patterns? Second, what are the consequences of financial integration of behavioral health? A preponderance of research has demonstrated that integrated primary care and behavioral health care can improve quality, but relatively little is known about how the methods of financing impact the degree of coordination and its effectiveness. Our study is specifically designed to decouple the specific impacts of spending reductions and financial integration from the contemporaneous policy changes (such as reliance on the medical home) that are occurring in both Oregon and Colorado. The proposed research will provide crucial knowledge for the development and design of innovations necessary to improve the long term value and affordability of health care.

Public Health Relevance

Our study evaluates the effects of major Medicaid program restructuring in Oregon, using Colorado as a control state. This study will provide early and critical information on policy approaches currently under consideration for Medicaid and Medicare programs - how to reduce health care spending (e.g., through reductions in unnecessary care, or through reductions in payment rates), and the implications of financial bundling of physical and mental health care.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HDM-R (52))
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Rupp, Agnes
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Oregon Health and Science University
Emergency Medicine
Schools of Medicine
United States
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McCarty, Dennis; Gu, Yifan; Renfro, Stephanie et al. (2018) Access to treatment for alcohol use disorders following Oregon's health care reforms and Medicaid expansion. J Subst Abuse Treat 94:24-28
McCarty, Dennis; Priest, Kelsey C; Korthuis, P Todd (2018) Treatment and Prevention of Opioid Use Disorder: Challenges and Opportunities. Annu Rev Public Health 39:525-541
Holton, Dwight; White, Elizabeth; McCarty, Dennis (2018) Public Health Policy Strategies to Address the Opioid Epidemic. Clin Pharmacol Ther 103:959-962
McConnell, K John; Renfro, Stephanie; Lindrooth, Richard C et al. (2017) Oregon's Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures. Health Aff (Millwood) 36:451-459
McConnell, K John; Renfro, Stephanie; Chan, Benjamin K S et al. (2017) Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado. JAMA Intern Med 177:538-545
McConnell, K John; Chernew, Michael E (2017) Controlling the Cost of Medicaid. N Engl J Med 377:201-203
McCarty, Dennis; Rieckmann, Traci; Baker, Robin L et al. (2017) The Perceived Impact of 42 CFR Part 2 on Coordination and Integration of Care: A Qualitative Analysis. Psychiatr Serv 68:245-249
Kim, Hyunjee; McConnell, K John; Sun, Benjamin C (2017) Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data. Popul Health Manag 20:271-277
Charlesworth, Christina J; Meath, Thomas H A; Schwartz, Aaron L et al. (2016) Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations. JAMA Intern Med 176:998-1004
McConnell, K John (2016) Oregon's Medicaid Coordinated Care Organizations. JAMA 315:869-70

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