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

项目摘要：《平价医疗法案》中的条款允许各州有相当大的灵活性和机会 重组他们的医疗补助计划。鉴于种族和少数民族地区所占比例不成比例 在医疗补助计划的覆盖下，医疗补助政策的变化提供了一个独特的机会来解决医疗保健问题 差距。然而，医疗补助政策也面临着重大挑战，特别是在以下方面 相对较低的报销保险计划给受益人留下了机会和质量方面的问题。其中之一 俄勒冈州已经发生了更雄心勃勃的医疗补助转型，该州推出了 “协调护理组织”，或CCOS，2012年。在概述CCO模式的立法中，国家 俄勒冈州明确将“健康公平和消除健康差距”确定为 交付系统发生了变化。CCOS必须：提交社区健康改善计划，目标为 缩小差距；提供地理位置靠近会员居住地和提供地的服务 可供不同社区和服务不足的人群使用的非传统环境；提供 鼓励将代表性不足的少数群体吸引到医疗保健工作队伍中；并扩大使用 社区卫生工作者。使用广泛的索赔和电子健康记录数据，并在 俄勒冈州的政策实验，这项提案旨在评估种族和民族差异 通过医疗补助改革减少，同时还跟踪医疗服务的准入和质量变化的程度 在这些重大的改革和扩张时期，农村人口和整个医疗补助计划。

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.