title: Early Performance in Medicaid Accountable Care Organizations: A Comparison of Oregon and Colorado.
abstract: Several state Medicaid reforms are under way, but the relative performance of different approaches is unclear.
  
  
  
  To compare the performance of Oregon's and Colorado's Medicaid Accountable Care Organization (ACO) models.
  
  
  
  Oregon initiated its Medicaid transformation in 2012, supported by a $1.9 billion investment from the federal government, moving most Medicaid enrollees into 16 Coordinated Care Organizations, which managed care within a global budget. Colorado initiated its Medicaid Accountable Care Collaborative in 2011, creating 7 Regional Care Collaborative Organizations that received funding to coordinate care with providers and connect Medicaid enrollees with community services. Data spanning July 1, 2010, through December 31, 2014 (18 months before intervention and 24 months after intervention, treating 2012 as a transition year) were analyzed for 452 371 Oregon and 330 511 Colorado Medicaid enrollees, assessing changes in outcomes using difference-in-differences analyses of regional focus, primary care homes, and care coordination. Oregon's Coordinated Care Organization model was more comprehensive in its reform goals and in the imposition of downside financial risk.
  
  
  
  Regional focus, primary care homes, and care coordination in Medicaid ACOs.
  
  
  
  Performance on claims-based measures of standardized expenditures and utilization for selected services, access, preventable hospitalizations, and appropriateness of care.
  
  
  
  In a total of 782 882 Medicaid enrollees, 45.0% were male, with mean (SD) age 16.74 (14.41) years. Standardized expenditures for selected services declined in both states during the 2010-2014 period, but these decreases were not significantly different between the 2 states. Oregon's model was associated with reductions in emergency department visits (-6.28 per 1000 beneficiary-months; 95% CI, -10.51 to -2.05) and primary care visits (-15.09 visits per 1000 beneficiary-months; 95% CI, -26.57 to -3.61), improvements in acute preventable hospital admissions (-1.01 admissions per 1000 beneficiary-months; 95% CI, -1.61 to -0.42), 3 of 4 measures of access (well-child visits, ages 3-6 years, 2.69%; 95% CI, 1.20% to 4.19%; adolescent well-care visits, 6.77%; 95% CI, 5.22% to 8.32%; and adult access to preventive ambulatory care, 1.26%; 95% CI, 0.28% to 2.25%), and 1 of 4 measures of appropriateness of care (avoidance of head imaging for uncomplicated headache, 2.59%; 95% CI, 1.35% to 3.83%).
  
  
  
  Two years into implementation, Oregon's and Colorado's Medicaid ACO models exhibited similar performance on standardized expenditures for selected services. Oregon's model, marked by a large federal investment and movement to global budgets, was associated with improvements in some measures of utilization, access, and quality, but Colorado's model paralleled Oregon's on several other metrics.
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Renfro
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
authors.forename: Benjamin K S
authors.initials: BK
authors.lastname: Chan
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
authors.forename: Thomas H A
authors.initials: TH
authors.lastname: Meath
authors.affiliation: Center for Health Systems Effectiveness, Oregon Health & Science University, Portland.
authors.forename: Aaron
authors.initials: A
authors.lastname: Mendelson
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, Portland.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cohen
authors.affiliation: Jefferson Center for Mental Health, Office of Healthcare Transformation, Wheat Ridge, Colorado.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Waxmonsky
authors.affiliation: OHSU-PSU School of Public Health, Oregon Health & Science University, Portland.
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.affiliation: Hatfield School of Government, Portland State University, Portland.
authors.forename: Neal
authors.initials: N
authors.lastname: Wallace
authors.affiliation: Department of Health Systems, Management and Policy, School of Public Health, University of Colorado, Denver.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Lindrooth
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000592:standards; D000293:Adolescent; D000328:Adult; D002648:Child; D003120:Colorado; D017598:Efficiency, Organizational; D005260:Female; D005380:Financing, Government / Q000379:methods; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration; D008484:Medicaid / Q000191:economics / Q000458:organization & administration; D017146:Models, Organizational; D009922:Oregon; D058996:Quality Improvement; D012040:Regional Health Planning; D014481:United States