Oregon’s Emphasis on Equity Shows Signs of Early Success for Black and American Indian Medicaid Enrollees

McConnell K, Charlesworth C, Meath T, George R, Kim H
Publication Year: 2018
Patient Need Addressed: Care Coordination/Management
Population Focus: Medicaid beneficiaries
Intervention Type: Service redesign, Staff design and care management
Study Design: Pre-post without Comparison Group
Type of Literature: White
link: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2017.1282
Abstract

In 2012, Oregon transformed its Medicaid program, providing coverage through sixteen coordinated care organizations (CCOs). The state identified the elimination of health disparities as a priority for the CCOs, implementing a multipronged approach that included strategic planning, community health workers, and Regional Health Equity Coalitions. We used claims-based measures of utilization, access, and quality to assess baseline disparities and test for changes over time. Prior to the CCO intervention there were significant white-black and white–American Indian/Alaska Native disparities in utilization measures and white-black disparities in quality measures. The CCOs’ transformation and implementation of health equity policies was associated with reductions in disparities in primary care visits and white-black differences in access to care, but no change in emergency department use, with higher visit rates persisting among black and American Indian/Alaska Native enrollees, compared to whites. States that encourage payers and systems to prioritize health equity could reduce racial and ethnic disparities for some measures in their Medicaid populations.

Insights Results

Care/quality outcomes

  • Compared to white enrollees, black enrollees had significantly higher emergency department (ED) visit rates (27% higher for overall ED visits and 31% higher for potentially avoidable ED visits). Black enrollees also had visit rates that were 14% lower than those of white enrollees for primary care and 11% lower for other outpatient visits
  • Compared to white enrollees, black enrollees had lower quality scores in three measures (access to preventive/ambulatory services by adults ages 45–64, access to those services by children ages 1–6, and preventable hospitalizations for chronic conditions). Relative to whites, American Indian/Alaska Native enrollees had similar quality measures, with the exception of the all-cause readmission rate measure
  • The white-black difference in primary care visits was reduced by 14.4 visits per 1,000 member months, representing a 36% reduction in the pre-intervention disparity
    Future considerations
  • Our results suggest that Oregon’s prioritization of disparities as a key target for Medicaid reform may have had some early successes. In particular, the use of data to measure and identify disparities may have allowed care coordination organizations (CCOs) to target key areas on which to focus
  • Overall, each part of Oregon’s multipronged approach—using transformation plans to set strategic goals and implement change, coordinating with Regional Health Equity Coalitions, and expanding the use of community health workers—was likely to raise the awareness of the existence of disparities in general and encourage actions to address specific health inequities within a CCO
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