Coordinated care model leads to decreases in unscheduled, preventable hospitalizations

Medicaid enrollees in Oregon are less likely to make unscheduled trips to the hospital following the implementation of the state's accountable-care model -- which researchers from Oregon State University think could be implemented in other states.

Their study suggests the Oregon system of coordinated care organizations, or CCOs, which has been serving Medicaid enrollees since 2012, can provide lessons to other states regarding the three-pronged pursuit of better health, better care and lower cost.

Among all types of patients, privately and publicly insured as well as the uninsured, hospitalizations account for nearly one-third of U.S. health expenditures, so reducing them in ways that don't compromise care is an important goal.

Health economist and health policy researcher Jangho Yoon of the OSU College of Public Health and Human Sciences, the study's lead author, and his collaborators analyzed Oregon Medicaid eligibility files from 2011 to 2013 for more than 86,000 women ages 15-44, looking at total hospital admissions: scheduled, unscheduled and preventable.

WHAT'S THE IMPACT

Scheduled admissions refer to hospitalizations for reasons that are elective. Unscheduled admissions are all non-elective hospitalizations, including transfers from other hospitals, direct admissions from outpatient providers and admissions through an emergency room. A preventable admission is one that arises from a condition that, if managed properly, could have been avoided or treated without hospitalization.

Elective hospital admissions between 2003 and 2009 remained stable, but non-elective admissions grew from 25.3 million to 26.7 million during that time, indicating that hospital emergency departments have become the primary gateway to inpatient care.

Oregon's 15 CCOs emphasize primary care, disease prevention and population health measurements, not just individual outcomes. They work with Medicaid patients under a lump sum payment system that rewards the CCOs for hitting certain quality standards, including efficient use of hospital emergency rooms.

Oregon is among 13 states with an accountable-care system for Medicaid patients and is considered to have implemented the most progressive model of accountable care.

Due to the decrease in preventable admissions in the study group, the study concluded the Oregon model may promote more efficient use of resources in the healthcare system, driven by primary care and strong financial incentives for care coordination.

THE LARGER TREND

A 2016 Nielsen survey, sponsored by the Council of Accountable Physician Practices, found that when it comes to patients' experiences with coordinated care, there's still some room for improvement.

The data was culled in order to gauge how the Affordable Care Act's delivery system reforms are progressing; these reforms include the process of transitioning to a value-based model from a fee-for-service framework. CAPP advocates for ACOs and other integrated delivery models.

Overall, coordination of care is improving, the survey found. But certain patients need additional support, like those saddled with multiple conditions, and the support they're receiving is at about the same level as those who are healthier.
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com