Funding Accountable Care in Oregon: Financial Models in Two Coordinated Care Organizations.

EXECUTIVE SUMMARY: Oregon's coordinated care organizations (CCOs) are an integral part of a massive statewide reform that brings accountable care to Medicaid. CCOs are regional collaboratives among health plans, providers, county public health, and communitybased organizations that administer a single global budget covering physical, mental, and dental healthcare for low-income Oregonians. CCOs have been given freedom within the global budget to implement reforms that might capture efficiencies in cost and quality. For this study-fielded between 2012 and 2015-we traced the path of the global budget through the interior structures of two of Oregon's most promising CCOs. Using document review and in-depth qualitative interviews, we synthesized and summarized descriptive narrative data to produce case studies of the financial models in each CCO. We found that the CCOs feature substantially different market contexts, governance models, organizational structures, and financial systems.

Connecting national survey data with DSM-IV criteria.

PURPOSE: To show how connections can be made among items in a nationally representative survey of adolescents and criteria for "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" (DSM-IV) diagnoses. METHODS: Data for this study came from the Wave I in-home interview of the National Longitudinal Study of Adolescent Health (Add Health), a nationwide study of approximately 90,000 adolescents and their parents. Proxy variables were developed for four DSM-IV diagnoses based on Wave I survey questions: conduct disorder, alcohol abuse, cannabis abuse, and major depressive disorder (single episode). Prevalence rates, comorbidity rates, and detailed item analyses of these four constructs are reported. RESULTS: Of the adolescents in the sample under study, 3.4% scored above the threshold for conduct disorder. For the alcohol abuse proxy 4.7% scored above the threshold, compared with 6.3% for the cannabis abuse proxy, and 1% scored above the threshold for major depressive disorder (single episode). Adolescents who scored above the threshold for conduct disorder were three times more likely to receive psychological counseling than adolescents who scored below the threshold for conduct disorder. The rates for alcohol abuse, cannabis abuse, and major depressive disorder (single episode) were 2.0, 3.0, and 5.0, respectively. CONCLUSIONS: The prevalence rates for the four constructs in the Add Health data set were generally lower or comparable to prevalence rates found in other epidemiological studies in which DSM-IV criteria were applied. The approach described in this study provides a way to identify adolescents who are likely at risk for the development of mental health problems.

The feasibility of paper-based Tracking Codes and electronic medical record systems to monitor tobacco-use assessment and intervention in an Individual Practice Association (IPA) Model health maintenance organization (HMO).

Despite evidence of its effectiveness, tobacco cessation is not systematically addressed in routine healthcare settings. Its measurement is part of the problem. A pilot study was designed to develop and implement two different tobacco tracking systems in two independent primary care offices that participated in an IPA Model health maintenance organization in Portland, Oregon. The first clinic, which utilized a paper-based charting system, implemented CPT-like tracking codes to measure and report tobacco-cessation activities, which were eventually included in the managed-care organization's (MCO) claims database. The second clinic implemented an electronic tracking system based on its computerized electronic medical record (EMR) charting system. This paper describes the pilot study, including the processes involved in building provider acceptance for the new tracking systems in these two clinics, the barriers and successes encountered during implementation, and the resources expended by the clinics and by the MCO during the pilot. The findings from the 3-month implementation period were that documentation of tobacco-use status remained stable at 42-45% in the paper-based clinic and increased from 79% to 88% in the EMR clinic. This pilot study demonstrated that Tracking Codes are a feasible preventive-care tracking system in paper-based medical offices. However, high levels of effort and support are needed, and a critical mass of insurers and health plans would need to adopt Tracking Codes before widespread use could be expected. Results of the EMR-based tracking system are also reviewed and discussed.