A Medicaid Alternative Payment Model Program In Oregon Led To Reduced Volume Of Imaging Services.

The patient-centered medical home model aspires to fundamentally restructure care processes, but a volume-based payment system may hinder such transformations. In 2013 Oregon's Medicaid program changed its reimbursement of traditional primary care services for selected community health centers (CHCs) from a per visit to a per patient rate. Using Oregon claims data, we analyzed the price-weighted volume of care for five service areas: traditional primary care services, including imaging, tests, and procedures; other services provided by CHCs that were carved out from the payment reform; emergency department visits; inpatient services; and other services of non-CHC providers. We further subdivided traditional primary care services using Berenson-Eggers Type of Service categories of care. We compared participating and nonparticipating CHCs in Oregon before and after the payment model was implemented. The payment reform was associated with a 42.4 percent relative reduction in price-weighted traditional primary care services, driven fully by decreased use of imaging services. Other outcomes remained unaffected. Oregon's initiative could provide lessons for other states interested in using payment reform to advance the patient-centered medical home model for the Medicaid population.

Project Nurture Integrates Care And Services To Improve Outcomes For Opioid-Dependent Mothers And Their Children.

Children born to women with substance use disorders are at high risk for early foster care placement, which is associated with long-term adverse outcomes for children and places additional pressure on state budgets. Poor outcomes for drug-dependent mothers and their children may be further exacerbated by a lack of coordination between the health care and human services sectors. Project Nurture is an innovative model in Portland, Oregon, that integrates maternity care, substance use treatment, and social service coordination for Medicaid beneficiaries. This study assessed the impact of Project Nurture on a range of patient and child welfare outcomes. Among the "treatment" population of opioid-dependent women enrolled in Medicaid, Project Nurture was associated with reductions in child maltreatment, placement of children in foster care, and increases in both prenatal visits and maternal lengths-of-stay in the hospital, compared to opioid-dependent women enrolled in Medicaid in Oregon counties not served by the project. These results suggest that models based in a clinical setting that engage the human services sector may improve overall outcomes, even though the difficulty in sharing savings across sectors presents challenges to sustainability.