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Hatfield School Receives Grants to Evaluate the Outcomes of Healthcare Reform in Oregon

by Amanda Lamb, MPA '10

Healthcare is certainly a hot-button issue these days. Not only do we hear the horror stories of individuals who either cannot access the healthcare they need because of cost or lack of access, but we also watch legislatures at the state and national level in a gridlock over how to fix it. In spite of the doom and gloom nature of the national conversation, progress has been made at both the state and national levels. New programs are always being created with the goal of improving healthcare quality and health in general. Some of these initiatives are happening here in Oregon, and the Hatfield School of Government is at the forefront in evaluating their impact on the system and the citizens it serves.

Dr. Jill Rissi, who started her career as an emergency room nurse and now teaches in both the Public Health and Public Administration programs in the Hatfield School, is working with healthcare agencies and research foundations to evaluate the current status of healthcare in Oregon and the impact current initiatives have on healthcare outcomes.

Coordinated Care Organizations

In Oregon, Coordinated Care Organizations, or CCOs, are essentially a network of healthcare providers that work together to provide comprehensive care to low income children and adults (under Medicaid). The purpose is to combine care for basic physical health, mental health, addiction treatment, and even dental care into one system with the goal of preventing major health crisis and managing chronic conditions. Not only are these systems meant to save money by preventing costly emergency room visits, but also to contribute to a healthier population.[1]

As part of partnership that includes PSU, the Providence Center for Outcomes Research and Education (CORE), and the Oregon Health Authority, Dr. Rissi will be evaluating the effects of that legislation and the creation of CCOs, including cost, utilization, and health outcomes. The research will be comprised of multiple areas of study, including a large survey designed to assess patients’ satisfaction levels and health outcomes; analysis of the “All Payer All Claims” database to evaluate healthcare utilization patterns and costs; and a qualitative study assessing the characteristics and functions of the CCOs themselves.

The overall goal of the research is to determine whether or not health has improved within this population. If the research suggests that health has improved, Dr. Rissi’s next objective will be to determine if the CCO model can be tied to those improved outcomes and, if so, what specific attributes of the CCO model lead to that positive impact.

Patient-Centered Primary Care Homes

To further the integration and coordination of care (similar and related to the CCOs), the Oregon legislature passed a bill creating a Patient-Centered Primary Care Home (PCPCH) model. The goals of the program are the same as those for the CCOs – to provide preventative care and manage chronic illnesses in an integrated, cost-effective, and patient-centered manner. These homes are an integral part of a comprehensive healthcare system, particularly for individuals that require multiple kinds of care (physical therapy, pain management, etc.) to manage their health conditions.

In order to become designated as a primary care home, certain criteria must be met. Dr. Rissi, in partnership with other PSU faculty (including Dr. Sherril Gelmon and Dr. Neal Wallace) and CORE, will conduct a study of the PCPCH model, including effects on cost, utilization, patient satisfaction and health outcomes. The study will include interviews, site visits and a survey of existing PCPCHs, and an analysis of documents that chronicle implementation of the PCPCH model.

Health Engagement Model

Dr. Rissi will also be engaged in analyzing the outcomes of efforts to reduce healthcare costs by incentivizing healthier lifestyles. As part of a nationwide trend toward “value-based benefit design” in healthcare coverage, the Oregon Public Employees Benefit Board (PEBB) began the Health Engagement Model program (HEM), which seeks to incentivize better health among public employees by offering lower health insurance premiums to those who avoid or end risky behaviors (e.g. smoking). Essentially, employees completed an online health assessment (weight, waist size, diet, etc.), and were encouraged to reduce risky behaviors and engage in a more healthy lifestyle through financial incentives. Although the program was not mandatory for state employees, those who did not participate paid a higher premium.  Dr. Rissi and her partners in the School of Community Health and at CORE will evaluate that program by surveying participants and those who opted out of HEM to determine its effects on health, healthcare costs and employee satisfaction.

Conclusion

All of these programs are about a national conversation about healthcare quality and cost – and health outcomes. Because they integrate the best of survey, claims analysis, and qualitative research methods; these research projects are able to assess variation in outcomes and to understand the relationship between what these new models of healthcare delivery are actually doing differently and how those differences affect individual and population health outcomes.