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Evaluation Options for Oregons Primary Care Transformation - - PowerPoint PPT Presentation
Evaluation Options for Oregons Primary Care Transformation - - PowerPoint PPT Presentation
Evaluation Options for Oregons Primary Care Transformation Initiative Who we are and why were here John McConnell Christina Charlesworth Stephanie Renfro Center for Health Systems Effectiveness (CHSE) Our mission is to provide the
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Who we are and why we’re here
John McConnell Christina Charlesworth Stephanie Renfro Center for Health Systems Effectiveness (CHSE) Our mission is to provide the analyses, evidence, and economic expertise to build a more sustainable health care system. Contract with OHA to develop PCTI evaluation options
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Use value-based payment methods to: » Increase investment in primary care
- Without increasing costs to consumers
- Without increasing total cost of care
» Align primary care reimbursement by all purchasers of care » Continue to improve reimbursement methods, including by investing in the social determinants of health
Oregon is pursuing ambitious reform efforts under SB934
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Considerations for evaluation design
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Payment model design and recommendations
Payment reform is a tool to support broader change
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Payment model design and recommendations Adoption of recommendations
Payment reform is a tool to support broader change
“Did this actually happen?”
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Payment reform is a tool to support broader change
Payment model design and recommendations Adoption of recommendations Increased primary care investment Aligned reimbursement Improved reimbursement methods (+ SDOH)
“If this actually happened- what were the effects?”
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Particular interest in: » Integration of behavioral health » Reduced administrative burden » Comprehensive patient-centered care » Better quality and patient outcomes
Payment reform is a tool to support broader change
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What evidence is needed?
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Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
Did spending on primary care services increase? By how much?
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What evidence is needed?
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Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
Did the total cost of care increase? Were consumer costs affected? What was the role of prices vs utilization?
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What evidence is needed?
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Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
Did payers increase their use of Collaborative-recommended payment methods? For example, did contracts including comprehensive population- based payments (HCP-LAN category 4B) increase?
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What evidence is needed?
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Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
What progress was made towards aligning reimbursement methods across payers?
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What evidence is needed?
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Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
Did service use patterns change? For example, did avoidable ED visits decrease? Did quality of patient care change? For example, did rates of chlamydia screening, adolescent well-care visits, or follow-up after hospitalization for mental illness increase?
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What evidence is needed?
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Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
Did payment methods facilitate clinic investment in social determinants of health?
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What evidence is needed?
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Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
Did clinics integrate behavioral and primary care practice? For example, did use of Collaborative-recommended billing codes to support integrated health clinics increase? Did clinic workflows change? For example, are there more warm hand-offs between primary care and behavioral health providers?
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Evaluation options
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How we got here
Challenges » What questions do we really care about answering? » What can we measure? Limits of administrative data » Constructing a treatment variable » Implementation vs participation » Hard to get at clinic-level
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How we got here
With a little help from our friends » PCTI Evaluation Workgroup » Collaborative meetings » OHA staff, Diana Bianco » Supplementary feedback from payers, providers
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How we got here
What we bring you today » Four evaluation options » Complementary » Not mutually exclusive » Evaluation Workgroup most interested in Options 1-3 (to start!)
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Option 1 Describe payment arrangements Option 2 Cross-state Commercial comparison Option 3 Cross-clinic Medicaid comparison Option 4 Qualitative clinic sample
Increased investment in primary care
X
Containment of total costs
- f care & costs to
consumers
X
Adoption of value-based payment methods
X X X
Alignment of value-based payment methods
X X
Improvement on utilization and quality measures
X X
Adoption of payment methods to address SDOH
X
Integration of physical and behavioral health
X X X
$
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Describe payment arrangements
1
Big-picture description of payment model adoption, and alignment of contracting arrangements over time
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Describe payment arrangements
1
$
Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
Big-picture description of payment model adoption, and alignment of contracting arrangements over time
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Describe payment arrangements
1
$
Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
Big-picture description of payment model adoption, and alignment of contracting arrangements over time » Includes all payers » Actionable information about implementation » Updates possible annually » Important context for interpreting other results » Hinges on payer-reported data
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Cross-state commercial comparison
2
Compare commercial patient outcomes in Oregon to control states before and after the Initiative
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Cross-state commercial comparison
2
Compare commercial patient outcomes in Oregon to control states before and after the Initiative
$
Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
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Cross-state commercial comparison
2
$
Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
» Strong design and methods will yield high quality evidence » Disentangles role of service use and price in total costs » Can inform return on investment question » Stakeholders do not need to report any data Compare commercial patient outcomes in Oregon to control states before and after the Initiative
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Cross-clinic Medicaid comparison
3
Compare Medicaid contracting arrangements and patient
- utcomes for Oregon PCTI vs. non-PCTI clinics
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Cross-clinic Medicaid comparison
3
Compare Medicaid contracting arrangements and patient
- utcomes for Oregon PCTI vs. non-PCTI clinics
$
Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
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Cross-clinic Medicaid comparison
3
Compare Medicaid contracting arrangements and patient
- utcomes for Oregon PCTI vs. non-PCTI clinics
$
Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
» Leverages CCO data on patient-clinic assignment & attribution » Study design weaker than Option 2 (eg, no control state) » Some implementation information, but for Medicaid only » CCOs and OHA need to report data
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Qualitative clinic sample
4
Survey a sample of clinics about microsystem changes related to VBP, behavioral health integration and SDOH
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Qualitative clinic sample
4
Survey a sample of clinics about microsystem changes related to VBP, behavioral health integration and SDOH
$
Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
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Qualitative clinic sample
4
Survey a sample of clinics about microsystem changes related to VBP, behavioral health integration and SDOH
$
Primary care investment Cost containment VBP adoption Payment alignment Service use & quality Behavioral health integration Payment for SDOH
» Rich information about clinic-level changes that is not available elsewhere » Relevant to all payers » Primary data collection is resource-intensive
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2018 2019 2020 2021 2022 2023 2024 YR 1 CPC+ Track 2 2025 2026 2027 YR 2 CPC+ Track 1, FQHCs, etc YR 3 Others
Collaborative convenes through 2027
Timeline
Implementation
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2018 2019 2020 2021 2022 2023 2024 YR 1 CPC+ Track 2 2025 2026 2027 YR 2 CPC+ Track 1, FQHCs, etc YR 3 Others
Collaborative convenes through 2027
Pre Period Implementation Post Period
Timeline
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2018 2019 2020 2021 2022 2023 2024 YR 1 CPC+ Track 2 2026 2027 YR 2 CPC+ Track 1, FQHCs, etc YR 3 Others
Collaborative convenes through 2027
Pre Period Implementation Post Period 2025 Get this admin data in 2025
Timeline
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2018 2019 2020 2021 2022 2023 2024 YR 1 CPC+ Track 2 2025 2027 YR 2 CPC+ Track 1, FQHCs, etc YR 3 Others
Collaborative convenes through 2027
Pre Period Implementation Post Period 2026 Deliver final report in 2026
Timeline
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» Flexibility in details » Synergy between options » Economies of scale
Other considerations
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Option 1 Describe payment arrangements Option 2 Cross-state Commercial comparison Option 3 Cross-clinic Medicaid comparison Option 4 Qualitative clinic sample
Increased investment in primary care
X
Containment of total costs
- f care & costs to
consumers
X
Adoption of value-based payment methods
X X X
Alignment of value-based payment methods
X X
Improvement on utilization and quality measures
X X
Adoption of payment methods to address SDOH
X
Integration of physical and behavioral health