Clinical trial NCT02637869: Evaluating Community Health Centers' Adoption of a New Global Capitation Payment
Official title: Evaluating Community Health Centers' Adoption of a New Global Capitation Payment
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Chronic Diseases
Keywords: Health Expenditures
Prospective Payment System
Health Care Utilization
Health Care Quality, Access, and Evaluation
Lead sponsor: Oregon Health and Science University
Sponsor class: OTHER
Collaborators: name: OCHIN, Inc.
name: Robert Wood Johnson Foundation
name: Agency for Healthcare Research and Quality (AHRQ)
First posted: 2015-12-22
Enrollment: 400000
Sex: ALL
Minimum age (years): 2
Maximum age (years): 64
Standard ages: CHILD
ADULT
Accepts healthy volunteers: yes
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Community Health Center (CHC) and clinic patients of which CHCs are participating in the APM demonstration (intervention) or are matched with APM CHCs (control)

Brief summary: 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: 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.

Eligibility criteria: Inclusion Criteria:

1. Total clinic population:

   established patients at intervention and control clinics aged 2-64
2. Medicaid Population:

Medicaid-enrolled patients at intervention and control clinics aged 2-64

Exclusion Criteria:

1. Total clinic population:

   non-established patients at intervention and control clinics aged 2-64
2. Medicaid Population:

non-Medicaid-enrolled patients at intervention and control clinics aged 2-64

Primary outcomes:
measure: Internal services utilization
timeFrame: ≤3 years pre-APM implementation and ≤3 years post
Secondary outcomes:
measure: Quality care measures
timeFrame: ≤3 years pre-APM implementation and ≤3 years post
measure: External services utilization
timeFrame: ≤3 years pre-APM implementation and ≤3 years post
measure: Medicaid expenditures
timeFrame: ≤3 years pre-APM implementation and ≤3 years post
Other outcomes:
measure: Study the change processes associated with APM implementation
timeFrame: ≤3 years pre-APM implementation and ≤3 years post
Locations:
Study officials:
affiliation: Oregon Health and Science University
name: John Heintzman, MD, MPH
role: PRINCIPAL_INVESTIGATOR
affiliation: Oregon Health and Science University
name: Heather Angier, MPH
role: STUDY_DIRECTOR
References:
citation: Heintzman J, Cottrell E, Angier H, O'Malley J, Bailey S, Jacob L, DeVoe J, Ukhanova M, Thayer E, Marino M. Impact of Alternative Payment Methodology on Primary Care Visits and Scheduling. J Am Board Fam Med. 2019 Jul-Aug;32(4):539-549. doi: 10.3122/jabfm.2019.04.180368.
citation: Angier H, O'Malley JP, Marino M, McConnell KJ, Cottrell E, Jacob RL, Likumahuwa-Ackman S, Heintzman J, Huguet N, Bailey SR, DeVoe JE. Evaluating community health centers' adoption of a new global capitation payment (eCHANGE) study protocol. Contemp Clin Trials. 2017 Jan;52:35-38. doi: 10.1016/j.cct.2016.11.001. Epub 2016 Nov 9.
citation: Cottrell EK, Hall JD, Kautz G, Angier H, Likumahuwa-Ackman S, Sisulak L, Keller S, Cameron DC, DeVoe JE, Cohen DJ. Reporting From the Front Lines: Implementing Oregon's Alternative Payment Methodology in Federally Qualified Health Centers. J Ambul Care Manage. 2017 Oct/Dec;40(4):339-346. doi: 10.1097/JAC.0000000000000198.