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

 描述（由申请人提供）：通过按服务收费模式补偿初级保健提供者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访问，这不一定会带来价值，质量和以患者为中心的护理。这在社区卫生中心（CHC）中尤其成问题，目前社区卫生中心的费用是根据预期支付系统（PPS）费率支付的，这是一种按服务收费的模式。为了改革社区卫生服务中心的这种支付模式，俄勒冈州开发了一种替代支付方法（APM），将PPS转换为大写等值。从2013年3月1日开始，八个社区卫生中心正在参与一个APM示范项目，其中所有的医疗补助收入将通过预期的、资本化的每个成员每月费率支付。该项目旨在（i）激励提供价值超过就诊量，（ii）支持为有复杂需求的患者提供综合治疗模式，以及（iii）使社区卫生中心能够将更多资源集中在人口健康举措上。所有8个APM社区卫生中心都是OCHIN社区卫生信息网络基于实践的研究网络的成员，该网络包括20个州的300多个社区卫生中心，拥有单一的共享电子健康记录。这种研究环境使我们能够确定没有参与APM的CHC，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（在2010年， 16个研究中心）的临床特征和基线服务利用水平。这种研究设计将使我们能够区分APM的影响与可能归因于 到同时进行的初级保健服务转型举措。 我们将研究与APM支付改革的自然实验相关的结果，解决以下具体目标：目标1：评估干预地点与对照地点相比，CHC服务（内部服务）利用率和临床护理质量的前后变化。目标2：衡量利用外部服务方面的离职前变化（例如，急诊科）和医疗补助计划的总成本之间的患者从干预诊所，与患者从控制诊所。社区卫生服务中心及其患者人群可能是受《患者保护和平价医疗法案》和其他政策变化影响最大的人群之一;因此，评估实践和政策变化如何影响社区卫生服务中心及其患者至关重要。 这项“自然实验”具有全国性的意义，因为它将完全取代CHCs的 PPS报销与全球资本每个成员每月付款直接从医疗补助。如果这一杀伤人员地雷被证明是有效的，研究结果将为在全国范围内传播类似的杀伤人员地雷提供信息。

 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.