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PubMed1994

Predicting the effect of the Oregon Health Plan on Medicaid coverage for outpatients with HIV.

The Oregon Health Plan, which took effect in February 1994, extends Medicaid eligibility but limits coverage to conditions and treatments above a certain threshold on a prioritized list. Retrospective analysis was conducted on records of visits to two Oregon human immunodeficiency virus (HIV) outpatient clinics in 1991 and 1992 to determine Medicaid coverage if the plan had been operational. Of 1129 patients, 21.1% were Medicaid-eligible; an additional 56.5% would have been eligible under the Oregon plan. Only 5.0% to 6.8% of these patients' visits were for conditions listed below the plan's coverage threshold; almost none of these were for HIV-specific conditions.

Ambulatory Care↗
PubMed2000

Access to substance abuse treatment services under the Oregon Health Plan.

CONTEXT: The shift to Medicaid managed care has raised numerous concerns about access to publicly funded substance abuse treatment. The implementation of a capitated chemical dependency benefit within the Oregon Health Plan in 1995 provided an opportunity to study the impact of funding mechanisms on access. OBJECTIVES: To determine to what extent access to publicly funded substance abuse treatment changed following the shift to managed care in Oregon and to examine factors associated with that change. DESIGN: Analysis of statewide treatment and Medicaid eligibility data. SETTING AND PATIENTS: All Medicaid-eligible persons aged 12 to 64 years who were enrolled in the Oregon Health Plan during 1994 (88,320), 1996 (170,387), 1997 (160,929), or 1998 (149,877). MAIN OUTCOME MEASURES: Access rates (the number of unique individuals admitted to treatment during a calendar year divided by the average number of enrolled members) computed before (1994) and after (1997) implementation of the capitated benefit. Analyses were replicated with data for 1996 and 1998. RESULTS: The percentage of Medicaid-eligible persons admitted to substance abuse treatment programs during a calendar year increased from 5.5% of the average number of enrolled members per month in 1994 to 7.7% in 1997, following the shift to managed care. For 1996 and 1998, the rates were 6.9% and 7.7%, respectively. Access rates varied considerably among the 7 largest prepaid health plans after adjusting for case mix. Operating characteristics of these prepaid health plans, such as the method of reimbursing treatment providers, were significant predictors of access after controlling for member characteristics. CONCLUSION: According to our analyses, Medicaid-eligible persons in Oregon observed an increase in access to substance abuse treatment after a shift to managed care. JAMA. 2000;284:2093-2099.

Adolescent↗
PubMed2002

Children in the Oregon Health Plan: how have they fared?

This study examines the impact of the Oregon Health Plan (OHP) on children's access to care. A telephone survey was conducted in 1998 of two groups of children: OHP enrollees and food stamp recipients not enrolled in OHP. Much of OHP's impact has been realized by the simple extension of health insurance coverage to Oregon's low-income children. The availability of insurance significantly increased the use of physician visits and dental care. The priority list had little effect on children, affecting only 2 percent of OHP children surveyed, most of whom succeeded in getting the service anyway. Thus, despite the negative publicity prior to its implementation, there is no evidence that "rationing" under OHP has substantially restricted access to needed services for children.

Aid to Families with Dependent Children↗
PubMed2001

Impact of the Oregon Health Plan on children with special health care needs.

OBJECTIVE: Although an increasing number of Medicaid children are enrolled in Medicaid managed care plans, little is known about how children with special health care needs fare under such programs. Of particular concern is the ability of such children to navigate a managed care system and gain access to specialty and other services. This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan. METHODOLOGY: Telephone surveys were conducted with a sample of parents of children enrolled in the Oregon Health Plan. Three groups of children were sampled: Supplemental Security Income (SSI) children with disabilities, children with asthma, and children without special health care needs. Descriptive and multivariate analyses were conducted to determine the impact of Medicaid managed care on access and satisfaction. RESULTS: Children with disabilities in managed care plans did not experience any more difficulty accessing needed specialty care than did those without special health care needs. Children with asthma, however, reported higher levels of unmet need. There were no differences in access between children with disabilities enrolled in managed care and those children with disabilities remaining in fee-for-service. CONCLUSIONS: Unlike SSI children with disabilities, children who were not SSI-eligible but had asthma seemed to have difficulty obtaining some services. These children were not eligible for the same consumer protections afforded SSI children by Oregon. If states want to enroll all children with special health care needs into managed care programs, they must develop mechanisms for identifying such children and ensuring that they receive medically necessary services.

Asthma↗
PubMed2006

Immunization initiation among infants in the Oregon Health Plan.

Infants who start receiving immunizations on time are more likely to be up to date at age 2 years. Among 39708 infants aged 3 months covered by the Oregon Health Plan (expanded Medicaid), those who did not have health care coverage within the first month of life were less likely to start receiving immunizations on time. Also at risk were infants in foster care, in subadoptive care, who were blind or disabled, who were Native American or Black, or whose mothers were not covered by the Oregon Health Plan.

Ethnicity↗
PubMed1997

An effective methodology for surveying a Medicaid population: the 1996 Oregon Health Plan client satisfaction survey.

There are many barriers to measuring client satisfaction for a Medicaid population. This vulnerable group is poor, often undereducated, and highly mobile, making both telephone surveys and mail-return surveys difficult to administer successfully. The Oregon Health Plan (OHP), a Medicaid managed care delivery system, has developed a client satisfaction survey and approach that yielded a 63% response rate. Readability, satisfaction indicators reflective of a Medicaid population, and survey administration are all identified as essential to an adequate response rate. The data from the 1996 Oregon Health Plan Client Satisfaction Survey are being used in the OHP's analysis and evaluation program and its ongoing quality improvement process.

Chronic Disease↗
PubMed2001

The Oregon Health Plan: predictors of office-based diabetic quality of care.

OBJECTIVE: In 1994, the Oregon Health Plan (OHP) expanded basic Medicaid insurance to residents under the federal poverty limit, adopted a prioritized limited benefits package, and converted to managed care. The quality of care in predominantly Medicaid populations with diabetes has not been previously described. In OHP enrollees, we examined predictors of diabetes care based on American Diabetes Association guidelines and described OHP diabetes care compared with national benchmarks. RESEARCH DESIGN AND METHODS: Chart abstraction and Medicaid data for 1995-1996 yielded 996 nonpregnant diabetic patients who were 18-64 years of age. Using HbA1c, lipid panel, and urine protein/microalbumin documentation ordered during the study year, we constructed a standard care (SC) index: SC for all three tests, mixed care (MC) for one to two tests, or no tests documented (NTD). RESULTS: Our sample was predominantly white, 48 +/- 11 years of age, 63% women, with 8 +/- 5 provider visits. Providers ordered HbA1c (70%), urine microalbumin/protein (57%), and lipid panel (41%) tests. Patients distributed into SC (22%), MC (62%), or NTD (16%). Thirteen variables predicted SC. Patients had a higher likelihood of SC if they were 18-24 years of age, had more clinic visits, were on insulin daily, were in several comorbid groups, were enrolled in salaried or capitated health plans, or lived in counties with more hospital beds. Four studies were used as comparable national benchmarks. CONCLUSIONS: Care provided to OHP patients with diabetes compares favorably with national benchmarks. Yet, most OHP patients with diabetes are still not achieving optimal care. Examining predictors of SC may play an important role in further policy development.

Adolescent↗
PubMed2002

Impact of the Oregon Health Plan on access and satisfaction of adults with low income.

OBJECTIVE: To evaluate the effects of the Oregon Health Plan (OHP) on beneficiary access and satisfaction. DATA SOURCES: Telephone survey of nondisabled adults in 1998. STUDY DESIGN: Two groups of adults were surveyed: OHP enrollees and Food Stamp recipients not enrolled in OHP. The Food Stamp sample included both privately insured and uninsured recipients. This allowed us to disentangle the insurance effects of OHP from other effects such as its reliance on managed care and the priority list. OHP and Food Stamp adults were compared along the following measures: usual source of care, utilization of health care services, unmet need, and satisfaction with care. DATA COLLECTION: The survey was conducted by telephone, using computer-assisted telephone interviewing techniques. PRINCIPAL FINDINGS: Much of OHP's impact has been realized by its extension of health insurance coverage to Oregon's low-income residents. The availability of health insurance significantly increased the utilization of many health care services and reduced unmet need for care. OHP was associated within a higher percentage of enrollees having a usual source of care and higher rates of Pap test screening among women compared with Food Stamp recipients. OHP enrollees also reported significantly higher use of dental care and prescription drugs; use we attribute to the expanded benefit package under the priority list. At the same time, OHP enrollees reported a greater unmet need for prescription drugs. Drug treatment for below-the-line conditions was one reason for this unmet need, but often the specific drug simply was not in the plan's formulary. OHP enrollees were as satisfied with their health care as those Food Stamp recipients with private health insurance. CONCLUSIONS: Despite the negative publicity prior to its implementation, there is no evidence that "rationing" under OHP's priority list has substantially restricted access to needed services. OHP adults appear to enjoy access equal to or better than that of low-income persons with private health insurance and have far greater access than the uninsured.

Adult↗
PubMed2006

Elimination of methadone benefits in the Oregon Health Plan and its effects on patients.

OBJECTIVES: This prospective study assessed the impacts of a policy change to Oregon's Medicaid program (Oregon Health Plan; OHP) that eliminated methadone benefits for 60 percent of active methadone patients. Recipients of OHP Standard (expanded Medicaid benefits, which were discontinued after the policy change) self-selected into two groups: those who paid for methadone after the policy change and those who terminated treatment. OHP Plus beneficiaries (traditional Medicaid) did not lose benefits. METHODS: A total of 149 patients participated in the study, and interviews were conducted at baseline (time of policy change) and one, three, and 12 months after the policy change. Patients were assessed with the Addiction Severity Index (ASI), Timeline Follow Back assessment, and chart review. RESULTS: Patients who left treatment because they were unable to pay for methadone services showed significant elevations in ASI composite scores for drug and legal problems at baseline and at two and three months after the policy change. The patients who attempted to self-pay experienced significantly more employment problems than the other two groups. The OHP Standard recipients who paid for their methadone treatment over the year were more likely to have additional resources to pay for methadone, be employed, and have stable housing. CONCLUSIONS: The elimination of methadone treatment benefits in the OHP had substantial negative impacts for patients with the greatest indicators of need.

Eligibility Determination↗
PubMed1999

The Oregon Health Plan and the political paradox of rationing: what advocates and critics have claimed and what Oregon did.

The article proceeds in three sections. First, we very briefly review the original proposals and ensuing (and misleading) debate over rationing in Oregon. Next, we explore how the politics of rationing unfolded in Oregon from the enactment of OHP to its implementation. Finally, we consider the character of Oregon's innovation and the broader lessons that it holds for reform efforts elsewhere.

Diffusion of Innovation↗
PubMedDate not supplied

Short-term impacts of coverage loss in a Medicaid population: early results from a prospective cohort study of the Oregon Health Plan.

PURPOSE: Medicaid programs in all 50 states recently implemented cost-saving strategies, including benefit reductions, cost sharing, and tightened administrative rules. These changes resulted in loss of insurance coverage for thousands of low-income adults nationwide. In this study we assessed the immediate impacts of disrupted and lost Medicaid coverage on adults enrolled in the Oregon Health Plan (OHP) when program changes were implemented. METHODS: Data come from baseline survey results of a prospective cohort study designed to assess the impacts of OHP changes on adult beneficiaries. We used bivariate and multivariate analyses to examine the effects of disrupted and lost insurance coverage on unmet health care needs, utilization, and medical debt occurring in the first 10 months after OHP changes were implemented. RESULTS: After OHP changes were implemented, 31% of enrolled adults reported losing coverage, and another 15% reported disrupted coverage. Controlling for demographic characteristics, income, and health status, those with disrupted coverage were less likely to have a primary care visit (odds ratio [OR] = .66; P <.05) and more likely to report unmet health care needs (OR = 1.85; P <.01) and medical debt (OR = 1.99; P <.01) when compared with those continuously insured. Those who lost coverage were less likely to have a primary care visit (OR = 0.18; P <.01) and more likely to report unmet health care needs (OR = 5.55; P <.01), unmet medication needs (OR = 2.05; P <01), and medical debt (OR = 3.06; P <.01) than those continuously insured. CONCLUSIONS: Medicaid program changes that increase cost sharing and limit enrollment have significant negative impacts on health care access and utilization among Medicaid beneficiaries; these impacts occur rapidly, within the first 10 months after changes.

Adult↗
PubMed2000

Integrating mental health into the Oregon Health Plan.

Public mental health has long struggled to be accepted as a part of health care. Its interface with social services and its broad spectrum of professionals make a clear definition of public mental health's boundaries difficult, fueling policymakers' skepticism about such acceptance. The Oregon Health Plan was the result of a process that explicitly included mental health but recognized that the tools for doing so need to be carefully developed.

Health Plan Implementation↗
PubMed2000

Evaluation of physician and patient compliance with the use of peak flow meters in commercial insurance and Oregon health plan asthmatic populations.

BACKGROUND: Home use of peak expiratory flow (PEF) meters is recommended by NIH management guidelines for patients with moderate to severe asthma. OBJECTIVE: To evaluate whether differences in physician PEF meter prescription patterns and patient compliance rates with PEF meter use exist between populations of commercially insured and Oregon Health Plan (OHP) patients. METHODS: A prospective, case-series study was conducted at the Bay Clinic Coos Bay, Oregon. Volunteers responded to a short survey. Patient asthma severity was evaluated by responses to the following questions: (1) frequency of shortness of breath per week, (2) daily and weekly frequency of albuterol rescue inhaler use, and (3) other prescription medications used. Additional questions included: (1) possession of a PEF meter, (2) physician instruction of meter use, (3) patient compliance with instructions, and (4) type of medical insurance. Using NIH asthma stratification guidelines, only respondents with moderate to severe asthma were included in this study. Respondents were age restricted to between 6 and 60 years. Incomplete surveys were not accepted. RESULTS: Ninety-six surveys were received and 54 accepted. Only 24 (44%) of the 54 respondents with moderate to severe asthma had a PEF meter. Nineteen (79%) used it according to physician instructions. Of the 29 patients reporting to have commercial insurance, 18 (62%) had a PEF meter and 15 (83%) used it as prescribed. Of the 21 asthmatic patients with OHP coverage, only 5 (24%) P = .007 had a peak flow meter and 4 (80%) used it as prescribed. CONCLUSIONS: We conclude physician prescription compliance of peak flow meters for asthma monitoring falls short of the NIH guidelines. When a PEF meter is prescribed, patients will likely use it regardless of their medical insurance. Significant differences exist in physician compliance with PEF meter prescription between populations of commercially insured and OHP patients. More study is necessary to further understand this divergence in care delivery.

Adolescent↗
PubMed2000

Background on the Oregon Health Plan.

Because of limited resources, the health care industry has been forced to choose how funds are spent. Public fee-for-service systems have begun to face the hard choices inherent in managed care. The Oregon Health Plan was designed to provide a rational approach to addressing these changes directly.

Health Care Rationing↗
PubMed1996

The ethical dilemmas of the Oregon health plan.

Escalating health care costs place our country at an economic disadvantage in the world marketplace. Currently, a mixture of rationing methods in the health care system limits access to control costs. Federal and state moneys fund the state Medicaid programs. States on limited budgets often tighten eligibility to far below the poverty level; those with benefits get unlimited care and those without get none. The state of Oregon has a different idea: Medicaid covers everyone below the poverty level but limits services to those with the "best cost-to-benefit ratio." Many people consider the distribution and finance of health care an ethical issue. The Oregon plan raises some ethical concerns and several arguments. The federal government waived Title XIX of the Social Security Act to allow implementation of the plan. Many providers believe universal access is important; however, the drive to see more patients may limit visit time.

Decision Making, Organizational↗
PubMed1993

Hospitals prepare for start of Oregon health plan prototype.

In March, the Clinton administration approved Oregon's controversial Medicaid rationing program, but said the state must revise its ranking of services to eliminate the possibility of bias against disabled people. Under the Oregon system, approximately 688 medical procedures and services were ranked according to their cost effectiveness. Based on projections of available funds, officials decided they wouldn't cover any treatment ranked below 568. But with the savings, the state will be able to provide Medicaid to the 120,000 Oregonians who now live below the poverty line, but don't receive Medicaid benefits.

Financing, Government↗