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

评估社区卫生中心采用新的全球按人头付费的情况

• 批准号: 8960110
• 负责人: Jennifer E DeVoe
• 金额: $ 25万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-10 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8960110
• 关键词: Evaluating; Community; Health; Centers; Adoption

 DESCRIPTION (provided by applicant): The common practice of reimbursing primary care providers through a fee-for-service model hampers efforts to develop patient-centered medical homes: it rewards a high volume of face-to-face clinic visits, which does not necessarily lead to value, quality, and patient-centered care. This is especially problematic in Community Health Centers (CHCs), which are currently paid based on the Prospective Payment System (PPS) rate, a fee- for-service model. To reform this payment model in CHCs, Oregon developed an Alternative Payment Methodology (APM) that converts PPS to a capitated equivalent. Eight CHCs are participating in an APM demonstration project, starting March 1, 2013, in which all of their Medicaid revenue will be paid through a prospective, capitated per-member per-month rate. The project seeks to (i) incentivize providing value over volume of visits, (ii) support comprehensive treatment modalities for patients with complex needs, and (iii) allow CHCs to focus more of their resources on population health initiatives. All 8 APM CHCs are members of the OCHIN community health information network practice-based research network, which includes over 300 CHCs in 20 states, with a single, shared electronic health record. This research environment enabled us to identify CHCs that are not participating in the APM, to serve as comparisons (controls). We used a distance- based matching algorithm to identify 8 "control" clinics that are matched with the 8 APM "intervention" sites (n ˜ 90,000 patients in the 16 study sites) with regard to clinic characteristics and baseline level of services utilization. Tis study design will allow us to differentiate the APM's effects from changes potentially attributable to concurrent primary care delivery transformation initiatives. We will study outcomes associated with the APM natural experiment in payment reform, addressing the following specific aims: Aim 1: Assess pre-post changes in utilization of CHC services (internal services), and quality of clinical care delivered in intervention sites, as compared with control sites. Aim 2 Measure pre-post changes in utilization of external services (e.g., emergency department) and overall costs to the Medicaid program among patients from intervention clinics, as compared to patients from control clinics. CHCs and their patient populations are likely to be among the most impacted by the Patient Protection and Affordable Care Act and other policy changes; therefore, it is critically important to evaluate how changes in practice and policy impact CHCs and their patients. This "natural experiment" has national significance, as it will completely replace CHCs' PPS reimbursement with a global capitated per-member-per-month payment directly from Medicaid. If this APM is proven effective, study findings will inform dissemination of similar APMs nationwide.

 描述（由申请人提供）：通过按服务收费模式向初级保健提供者提供补偿的常见做法阻碍了发展以患者为中心的医疗之家的努力：它奖励大量面对面的诊所就诊，这并不一定会带来价值、质量和以患者为中心的护理。这在社区健康中心 (CHC) 中尤其成问题，目前社区健康中心是根据预期支付系统 (PPS) 费率（一种按服务收费的模式）付费的。为了改革 CHC 的这种支付模式，俄勒冈州开发了一种替代支付方法 (APM)，将 PPS 转换为人头等值。八家 CHC 正在参与 APM 示范项目，该项目从 2013 年 3 月 1 日开始，其所有医疗补助收入将通过预期的按会员每月人均费率支付。该项目旨在 (i) 激励提供超过就诊量的价值，(ii) 支持针对具有复杂需求的患者的综合治疗方式，以及 (iii) 允许社区卫生中心将更多资源集中在人口健康举措上。所有 8 个 APM CHC 都是 OCHIN 社区健康信息网络实践研究网络的成员，该网络包括 20 个州的 300 多个 CHC，拥有单一、共享的电子健康记录。这种研究环境使我们能够识别未参与 APM 的 CHC，以作为比较（对照）。我们使用基于距离的匹配算法来识别与 8 个 APM“干预”站点相匹配的 8 个“对照”诊所（n ～ 90,000 名患者） 16 个研究中心）关于诊所特征和服务利用基线水平。这项研究设计将使我们能够将 APM 的影响与可能归因的变化区分开来。 同步初级保健提供转型举措。 我们将研究与支付改革中的 APM 自然实验相关的结果，解决以下具体目标： 目标 1：与对照地点相比，评估 CHC 服务（内部服务）使用前后的变化以及干预地点提供的临床护理质量。目标 2 与对照诊所的患者相比，衡量干预诊所患者外部服务（例如急诊科）利用率和医疗补助计划总体成本的前后变化。 CHC 及其患者群体可能是受《患者保护和平价医疗法案》和其他政策变化影响最大的群体之一；因此，评估实践和政策的变化如何影响社区卫生中心及其患者至关重要。 这个“自然实验”具有国家意义，它将完全取代CHC PPS 报销，直接从 Medicaid 直接按全球每位会员每月支付。如果该 APM 被证明有效，研究结果将为在全国范围内推广类似的 APM 提供参考。