Evaluating Community Health Centers' Adoption of a New Global Capitation Payment

Study Overview
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Brief Summary
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The investigators are conducting a prospective analysis of the Alternative Payment Methodology (APM) demonstration project sites. The investigators' goal is to conduct a cross project analysis of findings. The investigators propose to use mixed methods to study processes and outcomes associated with the APM natural experiment in payment reform. The investigators hypothesize that Community Health Centers (CHCs) participating in the APM demonstration project will redesign their workflows to better focus on patient and population health needs, resulting in reallocation of financial resources, lower overall costs, changes in utilization patterns, and improved quality.

Detailed Description
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Led by the Oregon Primary Care Association, three community health center (CHC) organizations in Oregon developed an Alternative Payment Methodology (APM). Under this APM pilot participating CHCs will receive a prospective payment system (PPS) payment as a capitated equivalent in a per-member-per-month rate for all of their Medicaid patients. Oregon CHC organizations (several clinic sites) implemented Phase I of this demonstration project on March 1, 2013; Phase II A was implemented on July 1, 2014; Phase II B on October 1, 2014; and Phase III began July 1, 2015. We are a prospective analysis of the APM project sites. We propose to use mixed methods to study processes and outcomes associated with the APM natural experiment in payment reform. We hypothesize that CHCs participating in the APM demonstration project will redesign their workflows to better focus on patient and population health needs, resulting in reallocation of financial resources, lower overall costs, changes in utilization patterns, and improved quality. The study will include baseline qualitative data collection as clinics are transitioning to the APM methodology. We will conduct 2 site visits to each intervention clinic to observe practice changes that occurred post APM-implementation (first visit approximately 12-18 months post-APM implementation; second visit approximately 30-36 months post-APM implementation). We will also assemble and analyze of pre-post quantitative and qualitative datasets, and interpretation and dissemination of study findings.

Official Title
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Evaluating Community Health Centers' Adoption of a New Global Capitation Payment

Conditions
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Chronic Diseases

Intervention / Treatment
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* Other: Alternative Payment Model


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Total clinic population: established patients at intervention and control clinics aged 2-64 Medicaid Population: Medicaid-enrolled patients at intervention and control clinics aged 2-64 Exclusion Criteria: Total clinic population: non-established patients at intervention and control clinics aged 2-64 Medicaid Population: non-Medicaid-enrolled patients at intervention and control clinics aged 2-64

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control Group - non-intervention<br>Clinics that did not participate in the APM project | |
| Alternative Payment Model -intervention<br>Oregon developed an Alternative Payment Methodology (APM). Under this APM pilot participating CHCs will receive a prospective payment system (PPS) payment as a capitated equivalent in a per-member-per-month rate for all of their Medicaid patients | Other: Alternative Payment Model<br>* Oregon developed an Alternative Payment Methodology (APM). Under this APM pilot participating CHCs will receive a prospective payment system (PPS) payment as a capitated equivalent in a per-member-per-month rate for all of their Medicaid patients<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Internal services utilization | Number and type of internal services utilized including number and ratio of traditional face to face visits vs. nontraditional encounters and communication via phone, personal health record, and email | ≤3 years pre-APM implementation and ≤3 years post | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality care measures | We selected measures that are: 1) identified by Oregon's Medicaid program and/or those on the list of Clinical Quality Measures in the electronic health record (EHR) incentive programs; 2) feasibly measured with EHR or Medicaid claims data; 3) representative across age groups and gender; 4) representative of treatment levels (e.g., prevention, acute and chronic condition care); and 5) relevant to CHC populations. | ≤3 years pre-APM implementation and ≤3 years post | 
| External services utilization | Number and type of external services utilized including percent of patients with a follow-up appointment after discharge and average wait time | ≤3 years pre-APM implementation and ≤3 years post | 
| Medicaid expenditures | We will calculate the average pre-post APM difference in total Medicaid expenditures attributable to the subpopulation of Medicaid-insured patients in APM intervention clinics, subtracted by the average difference among Medicaid-insured patients in comparison clinics | ≤3 years pre-APM implementation and ≤3 years post | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Expenditures, Prospective Payment System, Health Care Utilization, Health Care Quality, Access, and Evaluation