title: Oregon's Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures.
abstract: In 2012 Oregon initiated an ambitious delivery system reform, moving the majority of its Medicaid enrollees into sixteen coordinated care organizations, a type of Medicaid accountable care organization. Using claims data, we assessed measures of access, appropriateness of care, utilization, and expenditures for five service areas (evaluation and management, imaging, procedures, tests, and inpatient facility care), comparing Oregon to the neighboring state of Washington. Overall, the transformation into coordinated care organizations was associated with a 7 percent relative reduction in expenditures across the sum of these services, attributable primarily to reductions in inpatient utilization. The change to coordinated care organizations also demonstrated reductions in avoidable emergency department visits and improvements in some measures of appropriateness of care, but also exhibited reductions in primary care visits, a potential area of concern. Oregon's coordinated care organizations could provide lessons for controlling health care spending for other state Medicaid programs.
authors.affiliation: K. John McConnell (mcconnjo@ohsu.edu) is director of the Center for Health Systems Effectiveness and a professor in the Department of Emergency Medicine, both at Oregon Health and Science University, in Portland.
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.affiliation: Stephanie Renfro is a senior research associate in Center for Health Systems Effectiveness, Oregon Health and Science University.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Renfro
authors.affiliation: Richard C. Lindrooth is a professor in the Department of Health Systems, Management, and Policy at the Colorado School of Public Health, University of Colorado, Denver.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Lindrooth
authors.affiliation: Deborah J. Cohen is an associate professor in the Department of Family Medicine, Oregon Health and Science University.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Neal T. Wallace is a professor in the Oregon Health and Science University-Portland State University School of Public Health, in Portland.
authors.forename: Neal T
authors.initials: NT
authors.lastname: Wallace
authors.affiliation: Michael E. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chernew
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000592:standards; D002017:Budgets; D017046:Cost Savings; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005102:Health Expenditures; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D009922:Oregon; D011320:Primary Health Care / Q000706:statistics & numerical data; D014481:United States; D014861:Washington
keywords: Financing Health Care; Health Economics; Health Reform; Medicaid