New paper! Main takeaway: Oregon’s coordinated care system incentivizes Medicaid health plans to support clinics to improve patient outcomes, but the structure may worsen rural disparities by preferencing larger clinics. A thread with #systemsscience methods incoming – (1/12) doi.org/10.1017/cts.... - ThreadSky

ekenzie.bsky.social • 4 days ago

New paper! Main takeaway: Oregon’s coordinated care system incentivizes Medicaid health plans to support clinics to improve patient outcomes, but the structure may worsen rural disparities by preferencing larger clinics. A thread with #systemsscience methods incoming –
(1/12)
https://doi.org/10.1017/cts.2025.26

Comments

ekenzie.bsky.social•4 days ago

In Oregon, regional coordinated care organizations (CCOs) are contracted to administer Medicaid. We interviewed 12 of 13 CCOs to better understand the kind of support they provided to clinics, how they prioritized clinics to work with, and how they prioritized metrics to focus on.
(2/12)

ekenzie.bsky.social•4 days ago

The state sets quality metrics for certain preventive services and other aspects of care (e.g., alcohol & drug use screening, diabetes control). Because CCOs are paid based on how many of their members receive these services, they are incentivized to work with clinics to improve care. (3/12)

ekenzie.bsky.social•4 days ago

This is a causal-loop diagram of the basic structure of Oregon’s CCO system: When performance falls short of state metrics, clinics engage in quality improvement (QI) projects and CCOs are motivated to support clinics. CCO performance depends on clinics, so these feedback loops are nested. (4/12)

ekenzie.bsky.social•4 days ago

Quality improvement efforts can focus on improving care or improving how well clinics record and report that care, resulting in 2 feedback loops. (5/12)

ekenzie.bsky.social•4 days ago

CCOs reported supporting clinics with using their electronic health records, education & training, and understanding their performance with gap lists and dashboards. They also made an effort to build relationships with clinics. These distinct mechanisms are shown here. (6/12)

ekenzie.bsky.social•4 days ago

Because their performance is measured by the net # of members receiving a service, CCOs prioritize clinics with more of their members, which is often larger clinics. They also prioritize clinics with the motivation and capacity to work with them. (7/12)

Comments

Posting Rules

Reply