In August 2012, Oregon began enrolling Medicaid beneficiaries in coordinated care organizations (CCOs), a unique mandatory-enrollment accountable care organization (ACO) model with payment methods strongly tied to preventive care; care coordination; and integration of physical, mental and dental health care through patient-centered medical homes. This dissertation, consisting of two studies, examined the impact of the new delivery model on healthcare utilization and mortality among infants enrolled in Medicaid. Also, it investigated if the CCO model had heterogeneous impacts for preterm and full-term infants and if the effect of CCOs changed over the implementation timeline.
Study 1 examined the extent to which CCOs had effects on healthcare utilization of infants during their two years of birth. Using Oregon birth certificates, Medicaid enrollment data, Medicaid claims, and hospital discharge data, a sample of 77,101 pre-CCO infants and 90,775 post-CCO infants was created whose healthcare utilization was followed for two years after birth. Service utilization outcomes included pediatric preventive care services, i.e., well-child visits and developmental screenings, emergency department (ED) visits, and hospital admissions. This study found that infants enrolled in CCOs received more preventive services compared to their pre-CCO counterparts. Impacts of CCOs on preventive care services also grew over the CCO implementation timeline. ED visits slightly increased and hospital admissions reduced after CCO implementation but not statistically significant. No statistically significant difference was found in the effects of CCOs on service utilization between preterm infants and full-term infants.
Study 2 investigated the impact of CCO implementation on neonatal and infant mortality. The sample consisted of the pre-CCO birth cohort of 136,519 infants and the post-CCO birth cohort of 149,523 infants. Using difference-in-differences approach, the CCO model was found to be significantly associated with a reduction in both neonatal mortality (68% compared to the pre-CCO level) and infant mortality (37% compared to the pre-CCO level), and also with a greater reduction in infant mortality among preterm infants compared to full-term infants. The impact on infant mortality also grew in magnitude over the post implementation timeline.
CCOs should continue their strategies to improve preventive care and health outcomes for infants. Given the plan to incorporate more specific policies to address children’s health in the next phase of CCO implementation in 2020-2024, future research should further investigate the effects of CCOs on utilization of ED and inpatient services and cost of care for children, as well as how CCOs would have an impact on different high-risk children populations.