Clinical Trials Logo

Clinical Trial Details — Status: Active, not recruiting

Administrative data

NCT number NCT02637869
Other study ID # AHRQ R01HS22651
Secondary ID 71125
Status Active, not recruiting
Phase
First received
Last updated
Start date July 2015
Est. completion date May 2020

Study information

Verified date October 2019
Source Oregon Health and Science University
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

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.


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.


Recruitment information / eligibility

Status Active, not recruiting
Enrollment 400000
Est. completion date May 2020
Est. primary completion date May 2020
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 2 Years to 64 Years
Eligibility 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

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Alternative Payment Model
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

Locations

Country Name City State
n/a

Sponsors (4)

Lead Sponsor Collaborator
Oregon Health and Science University Agency for Healthcare Research and Quality (AHRQ), Ochin, Inc., Robert Wood Johnson Foundation

References & Publications (3)

Angier H, O'Malley JP, Marino M, McConnell KJ, Cottrell E, Jacob RL, Likumahuwa-Ackman S, Heintzman J, Huguet N, Bailey SR, DeVoe JE. Evaluating community health centers' adoption of a new global capitation payment (eCHANGE) study protocol. Contemp Clin T — View Citation

Cottrell EK, Hall JD, Kautz G, Angier H, Likumahuwa-Ackman S, Sisulak L, Keller S, Cameron DC, DeVoe JE, Cohen DJ. Reporting From the Front Lines: Implementing Oregon's Alternative Payment Methodology in Federally Qualified Health Centers. J Ambul Care Ma — View Citation

Heintzman J, Cottrell E, Angier H, O'Malley J, Bailey S, Jacob L, DeVoe J, Ukhanova M, Thayer E, Marino M. Impact of Alternative Payment Methodology on Primary Care Visits and Scheduling. J Am Board Fam Med. 2019 Jul-Aug;32(4):539-549. doi: 10.3122/jabfm.2019.04.180368. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Other Study the change processes associated with APM implementation Qualitative assessment of practice change through interviews and site visits =3 years pre-APM implementation and =3 years post
Primary Internal services utilization Number and type of internal services utilized including number and ratio of "traditional" face to face visits vs. "nontraditional" encounters and communication via phone, personal health record, and email =3 years pre-APM implementation and =3 years post
Secondary Quality care measures We selected measures that are: 1) identified by Oregon's Medicaid program and/or those on the list of Clinical Quality Measures in the electronic health record (EHR) incentive programs; 2) feasibly measured with EHR or Medicaid claims data; 3) representative across age groups and gender; 4) representative of treatment levels (e.g., prevention, acute and chronic condition care); and 5) relevant to CHC populations. =3 years pre-APM implementation and =3 years post
Secondary External services utilization Number and type of external services utilized including percent of patients with a follow-up appointment after discharge and average wait time =3 years pre-APM implementation and =3 years post
Secondary Medicaid expenditures We will calculate the average pre-post APM difference in total Medicaid expenditures attributable to the subpopulation of Medicaid-insured patients in APM intervention clinics, subtracted by the average difference among Medicaid-insured patients in comparison clinics =3 years pre-APM implementation and =3 years post
See also
  Status Clinical Trial Phase
Completed NCT02694796 - Impact of Web and Smartphone-based Physical Activity Program on Physical Activity Level 12 Months After a Balneotherapy N/A
Completed NCT02351648 - A Randomised Control Trial of a Transitional Care Model in Singapore General Hospital N/A
Completed NCT00772733 - A Project Ensuring Quality and Cooperation in the Chronic Obstructive Pulmonary Disease (COPD) Treatment N/A
Completed NCT00126737 - Home-Based Exercise and Weight Control Program for Pain Control in Overweight Elderly With Osteoarthritis of the Knee N/A
Completed NCT01719991 - Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support N/A
Completed NCT00569595 - Improving Health Habits in Impoverished Populations Phase 3
Completed NCT00309296 - Longitudinal Care: Smoking Reduction to Aid Cessation N/A
Completed NCT02487589 - Falls in Elderly and Telehealth: a Randomized Controlled Study N/A
Recruiting NCT00172926 - Study on the Relationship Between Physical Constitution and Diseases N/A
Completed NCT00222703 - Enhancing Tobacco Abstinence Following Hospitalization N/A
Recruiting NCT05233917 - Dietary Metabolic Signatures in Health Study
Active, not recruiting NCT05247632 - Precision Nutrition and Food Safety for Dietary Prevention of Chronic Disease Study
Completed NCT02885129 - Development of the General Scale Observance for Chronic Diseases N/A
Completed NCT01832064 - Active Living Tool Kit for Chronic Conditions N/A
Completed NCT01625468 - Brief Interventions to Create Smoke-Free Home Policies in Low-Income Households N/A
Completed NCT00341536 - Feasibility Study for Prospective Diet and Lifestyle Cohorts in Delhi, Kerala, and Kolkota, India
Not yet recruiting NCT06046326 - Evaluate the Effectiveness of a Virtual Community of Practice N/A
Completed NCT06179238 - Urinary Catheter Self-care Management N/A
Completed NCT02191111 - A Cluster-randomized Controlled Knowledge Translation Feasibility Study in Alberta Community Pharmacies N/A
Completed NCT01372137 - First-in-human Study to Evaluate the Safety, Tolerability, Pharmacokinetics and Pharmacodynamics of NOX-H94 Phase 1