Oregon's Coordinated Care Organizations Increased Timely Prenatal Care Initiation And Decreased Disparities.
Policies at the state and federal levels affect access to health services, including prenatal care. In 2012 the State of Oregon implemented a major reform of its Medicaid program. The new model, called a coordinated care organization (CCO), is designed to improve the coordination of care for Medicaid beneficiaries. This reform effort provides an ideal opportunity to evaluate the impact of broad financing and delivery reforms on prenatal care use. Using birth certificate data from Oregon and Washington State, we evaluated the effect of CCO implementation on the probability of early prenatal care initiation, prenatal care adequacy, and disparities in prenatal care use by type of insurance. Following CCO implementation, we found significant increases in early prenatal care initiation and a reduction in disparities across insurance types but no difference in overall prenatal care adequacy. Oregon's reforms could serve as a model for other Medicaid and commercial health plans seeking to improve prenatal care quality and reduce disparities.
Ifeoma Muoto (muotoi@oregonstate.edu) is an Administrative Fellow at Kaiser Permanente, Southern California Region, in Harbor City, California. She was a doctoral candidate in the Health Management and Policy program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, at Oregon State University, in Corvallis, and a research associate in the Department of Obstetrics and Gynecology at Oregon Health and Science University, in Portland, when this research was conducted.
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Jeff Luck is an associate professor in the Health Management and Policy program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University.
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Luck
Jangho Yoon is an assistant professor of health policy in the Health Management and Policy program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University.
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Yoon
Stephanie Bernell is an associate professor of health policy in the School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University.
Stephanie
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Bernell
Jonathan M. Snowden is an assistant professor in the Department of Obstetrics and Gynecology at Oregon Health and Science University and at the Oregon Health and Science University/Portland State University School of Public Health.
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D000328:Adult; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D009922:Oregon; D009936:Organizational Innovation; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D012040:Regional Health Planning / Q000191:economics / Q000458:organization & administration*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014861:Washington; D055815:Young Adult
Disparities; Maternal And Child Health; Medicaid; Organization and Delivery of Care