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

Chronic Diseases Clinical Trial

— eCHANGE  

Official title:

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

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT02637869
• Other study ID #: AHRQ R01HS22651
• Secondary ID: 71125
• Status: Active, not recruiting
• 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
• 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

Related Conditions & MeSH terms

• Chronic Disease
• Chronic Diseases

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