Assessing the Potential for a State Medicaid Reform Model to Reduce Disparities

项目摘要：《平价医疗法案》的规定允许各州有很大的灵活性和机会， 重组他们的医疗补助计划鉴于少数种族和族裔地区所占比例过高， 医疗补助计划涵盖的医疗费用，医疗补助政策的变化提供了一个独特的机会， 差距。然而，医疗补助政策也面临着重大挑战，特别是在这种方式， 相对低偿还保险方案给受益人留下了机会和质量问题。之一 更雄心勃勃的医疗补助改革发生在俄勒冈州，该州推出了医疗补助制度， 2012年，“协调护理组织”或CCO。在概述共同合作组织模式的立法中， 俄勒冈州明确将“健康公平和消除健康差距”确定为 交付系统的变化。社区卫生组织必须：提交社区卫生改善计划，目标是 减少差异;提供地理位置靠近成员居住地的服务， 不同社区和得不到充分服务的人口可以利用的非传统环境; 激励措施，吸引代表性不足的少数群体进入卫生保健工作队伍; 社区卫生工作者。使用广泛的索赔和电子健康记录数据， 作为俄勒冈州的一项政策实验，这项提案旨在评估种族和民族差异如何能够 通过医疗补助改革减少，同时还跟踪获得和质量变化的程度， 农村人口和医疗补助计划在这些重大的改革和扩张时期。

Project Summary: Provisions in the Affordable Care Act allow states substantial flexibility and opportunity to restructure their Medicaid programs. Given the disproportionate share of racial and ethnic minorities areas covered by the Medicaid program, changes in Medicaid policy provide a unique opportunity to address health disparities. However, Medicaid policies also face significant challenges, particularly in the ways in which this relatively low-reimbursing insurance program has left beneficiaries with problems of access and quality. One of the more ambitious Medicaid transformations has occurred in Oregon, which launched its system of “Coordinated Care Organizations,” or CCOs, in 2012. In legislation outlining the CCO model, the State of Oregon explicitly identified “Health Equity and Eliminating Health Disparities” as a fundamental target for delivery system changes. CCOs are required to: submit Community Health Improvement Plans, with goals for reducing disparities; provide services geographically located close to where members reside and offered in nontraditional settings that are accessible to diverse communities and underserved populations; provide incentives to attract underrepresented minority groups into the healthcare workforce; and broaden the use of community health workers. Using extensive claims and Electronic Health Record data and building on large policy experiment in Oregon, this proposal aims to assess the ways in which racial and ethnic disparities can be reduced through Medicaid reform, while also tracking the extent to which access and quality change for rural populations and the Medicaid program at large during these significant reform and expansion periods.