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

Oregon Health & Science University (OHSU)

Status: Unknown

Conditions: Chronic Diseases

Treatments: Other: Alternative Payment Model

Study type: Observational

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT02637869

AHRQ R01HS22651

71125 (Other Grant/Funding Number)

Details and patient eligibility

About

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.

Full 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.

Enrollment: 400,000 estimated patients

Sex: All

Ages: 2 to 64 years old

Volunteers: Accepts Healthy Volunteers

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

Trial design

400,000 participants in 2 patient groups

Control Group - non-intervention

Description:

Clinics that did not participate in the APM project

Alternative Payment Model -intervention

Description:

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

Treatment:

Other: Alternative Payment Model