Online Program

Impact of Integrated Care Delivery on Emergency Department Use Among Female Medicaid Enrollees: A Natural Experiment in Oregon's Coordinated Care Organizations

Tuesday, November 3, 2015 : 1:30 p.m. - 1:50 p.m.

Jangho Yoon, MSPH, PhD, College of Public Health and Human Sciences, Health Policy and Management Program, Oregon State University, Corvallis, OR
Jeff Luck, PhD, MBA, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
S. Marie Harvey, DrPH, MPH, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
Objectives: Oregon’s coordinated care organizations (CCOs) transform the way healthcare is delivered for Medicaid enrollees, by integrating the provision of medical, behavioral, and oral health services.  This study examines whether implementation of CCOs has affected emergency department (ED) use among women of reproductive age (15-44 years old).  Reducing avoidable ED use among this large population of adult Medicaid enrollees was a goal of the CCO reform. 

Methods: Using enrollment and claims records from January 2011 to July 2013, we created person-month panel data on 665,650 female Oregon Medicaid enrollees (N = 7,985,846).  Utilizing the fact that some CCOs began operations earlier than others, we perform a quasi-experimental analysis that compares the difference in ED visits between pre- and post-CCO implementation periods for CCO enrollees compared to the difference for non-CCO Medicaid enrollees.  Two-part difference-in-differences count data models are estimated. The models control for individual heterogeneity.

Results: The monthly probability of ED use among Oregon women of reproductive age enrolled in Medicaid decreased on average by 0.14 percentage points following the implementation of CCOs (p < .01)–an approximately 1 percent reduction in the probability of ED use before CCO implementation.  The magnitude of the relationship varies by CCO, and is larger for nonwhites.  On average the frequency of ED use decreased after CCOs began operating although this relationship is not statistically significant.

Conclusion: During the first year of implementation, Oregon CCOs led to a reduction in ED use. Future evaluations can benefit from understanding factors contributing to variation across CCOs.

Learning Areas:

Provision of health care to the public
Public health administration or related administration
Public health or related public policy
Public health or related research
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Explain Oregon’s Coordinated Care Organizations (CCOs) and innovations in healthcare delivery and integration. Discuss to what extent Oregon’s healthcare system integration through CCOs led to reductions in ED use among women enrolled in Medicaid.

Keyword(s): Health Systems Transformation, Women's Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am currently a Co-I on a multi-year project that evaluates the impact of Medicaid expansion and healthcare system integration in Oregon on women of reproductive age and their infants. I am a health economist who has analyzed big data from various administrative sources including Medicaid claims and applied quasi-experimental research designs to evaluate health policy and system changes on health care utilization for the past 15 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.