Wright Bill J, Royal Natalie, Broffman Lauren, Li Hsin-Fang, Dulacki Kristen
J Healthc Qual. 2019 Jul/Aug;41(4):e38-e46. doi: 10.1097/JHQ.0000000000000178.
In 2012, Oregon embarked on an ambitious plan to redesign financing and care delivery for Medicaid. Oregon's Coordinated Care Organizations (CCOs) are the first statewide effort to use accountable care principles to pay for Medicaid benefits. We surveyed 8,864 Medicaid-eligible participants approximately 1 year before and 12 months after CCO implementation to assess the impact of CCOs on member-reported outcomes. We compared changes in outcomes over time between Medicaid CCO members, Medicaid fee-for-service (FFS) members, and those who were uninsured. After 1 year, Medicaid beneficiaries enrolled in CCOs reported better access to care, better quality care, and better connections to primary care than Medicaid FFS or uninsured persons. We did not find early evidence of improvements in preventive care and screenings or in ED utilization. Although these are early indicators, results suggest that Oregon's delivery system transformation is having a positive impact on patient experience outcomes.
2012年，俄勒冈州着手实施一项宏伟计划，重新设计医疗补助的融资和医疗服务提供方式。俄勒冈州的协调护理组织（CCO）是全州范围内首次运用责任医疗原则来支付医疗补助福利的举措。我们在CCO实施前约1年及实施后12个月对8864名符合医疗补助条件的参与者进行了调查，以评估CCO对成员报告结果的影响。我们比较了医疗补助CCO成员、医疗补助按服务收费（FFS）成员以及未参保者在不同时间的结果变化。1年后，加入CCO的医疗补助受益人报告称，与医疗补助FFS成员或未参保者相比，他们获得医疗服务的机会更多、医疗质量更高，与初级医疗的联系也更紧密。我们没有发现预防保健和筛查或急诊室利用率改善的早期证据。尽管这些只是早期指标，但结果表明俄勒冈州的医疗服务体系转型正在对患者体验结果产生积极影响。
