Search

Search Results

• 1. [Article] Characteristics of Medicaid Clients in Assisted Living, Residential Care, Memory Care, and Adult Foster Homes 2013-2014

  In collaboration with the Aging and People with Disabilities (APD) program of Oregon’s Department of Human Services (DHS), Portland State University’s Institute on Aging generated this report of Medicaid ...

  Citation × Citation Citation Abstract Copy Title: Characteristics of Medicaid Clients in Assisted Living, Residential Care, Memory Care, and Adult Foster Homes 2013-2014 Author: Carder, Paula C., Kohon, Jacklyn Nicole, Elliott, Sheryl DeJoy, West, Maximilian, Zimam, Amanuel, Neal, Margaret B. Year: 2014 In collaboration with the Aging and People with Disabilities (APD) program of Oregon’s Department of Human Services (DHS), Portland State University’s Institute on Aging generated this report of Medicaid clients living in community-based care (CBC) settings in the state of Oregon. The Oregon legislature appropriated funds for DHS to collect information about these community-based care providers which will allow DHS, providers, and the public to better understand characteristics of Medicaid clients living in different CBC settings. This report is based on an analysis of Medicaid data provided by DHS. The study goals were to: describe Medicaid clients’ health-related needs, service use, and demographic characteristics; provide a baseline for future reports. In addition, this information about Medicaid clients can be compared to the recently completed summary of assisted living facilities (ALF), residential care facilities (RCF), memory care communities (MCC), and adult foster homes (AFH) completed by Portland State University’s Institute on Aging. All three CBC reports and a report recently completed by Oregon State University on nursing facilities in Oregon, provide an important overview of community-based and long-term care settings in Oregon that can be used by policymakers, providers, and consumers. Title: Characteristics of Medicaid Clients in Assisted Living, Residential Care, Memory Care, and Adult Foster Homes 2013-2014 Author: Carder, Paula C., Kohon, Jacklyn Nicole, Elliott, Sheryl DeJoy, West, Maximilian, Zimam, Amanuel, Neal, Margaret B. Year: 2014 In collaboration with the Aging and People with Disabilities (APD) program of Oregon’s Department of Human Services (DHS), Portland State University’s Institute on Aging generated this report of Medicaid clients living in community-based care (CBC) settings in the state of Oregon. The Oregon legislature appropriated funds for DHS to collect information about these community-based care providers which will allow DHS, providers, and the public to better understand characteristics of Medicaid clients living in different CBC settings. This report is based on an analysis of Medicaid data provided by DHS. The study goals were to: describe Medicaid clients’ health-related needs, service use, and demographic characteristics; provide a baseline for future reports. In addition, this information about Medicaid clients can be compared to the recently completed summary of assisted living facilities (ALF), residential care facilities (RCF), memory care communities (MCC), and adult foster homes (AFH) completed by Portland State University’s Institute on Aging. All three CBC reports and a report recently completed by Oregon State University on nursing facilities in Oregon, provide an important overview of community-based and long-term care settings in Oregon that can be used by policymakers, providers, and consumers. Close

• 2. [Article] Oregon Community-Based Care Survey: Assisted Living, Residential Care, and Memory Care

  This report, prepared by the Institute on Aging (IOA) at Portland State University (PSU) in collaboration with the Oregon Department of Human Services, describes community-based care (CBC) settings that ...

  Citation × Citation Citation Abstract Copy Title: Oregon Community-Based Care Survey: Assisted Living, Residential Care, and Memory Care Author: Carder, Paula C., Kohon, Jacklyn Nicole, Limburg, Aubrey, Zimam, Amanuel, Rushkin, Megan, Neal, Margaret B. Year: 2016 This report, prepared by the Institute on Aging (IOA) at Portland State University (PSU) in collaboration with the Oregon Department of Human Services, describes community-based care (CBC) settings that provide residential, personal care, and health-related services, primarily to older adults. The study collected information from assisted living, residential care, and memory care communities to achieve the following four main goals. Describe assisted living, residential care, and memory care community characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results to prior Oregon surveys and to national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or costs The study findings are intended to provide information that state agency staff, legislators, community-based care providers, and consumers might use to guide their decisions. Providing state-level information was one of the goals of Oregon’s LTC 3.0 planning process (Oregon Department of Human Services, n.d.). In addition, as possible, comparisons are made to national surveys of residential care and assisted living conducted by the National Center for Health Statistics. Because of state variation in licensure categories, the national surveys combine residential and assisted living settings and use the term residential care to describe both. It should also be noted that regulatory standards and the types of residents that can be served in AL and RC settings vary by state, as well. Title: Oregon Community-Based Care Survey: Assisted Living, Residential Care, and Memory Care Author: Carder, Paula C., Kohon, Jacklyn Nicole, Limburg, Aubrey, Zimam, Amanuel, Rushkin, Megan, Neal, Margaret B. Year: 2016 This report, prepared by the Institute on Aging (IOA) at Portland State University (PSU) in collaboration with the Oregon Department of Human Services, describes community-based care (CBC) settings that provide residential, personal care, and health-related services, primarily to older adults. The study collected information from assisted living, residential care, and memory care communities to achieve the following four main goals. Describe assisted living, residential care, and memory care community characteristics, including staffing types and levels, policies, and monthly charges and fees Describe current residents’ health and social characteristics Compare current results to prior Oregon surveys and to national studies of similar setting types to identify changes and possible trends Compare setting types for differences that might affect access, quality, or costs The study findings are intended to provide information that state agency staff, legislators, community-based care providers, and consumers might use to guide their decisions. Providing state-level information was one of the goals of Oregon’s LTC 3.0 planning process (Oregon Department of Human Services, n.d.). In addition, as possible, comparisons are made to national surveys of residential care and assisted living conducted by the National Center for Health Statistics. Because of state variation in licensure categories, the national surveys combine residential and assisted living settings and use the term residential care to describe both. It should also be noted that regulatory standards and the types of residents that can be served in AL and RC settings vary by state, as well. Close

• 3. [Article] Oregon's Health Insurance Coverage Holds Steady, but the State's Uninsured Rate Remains High

  Data released in August 2012 from the U.S. Census Bureau’s Small Area Health Insurance Estimates (SAHIE) program show that Oregon continues to have one of highest rates of uninsured residents in the U.S. ...

  Citation × Citation Citation Abstract Copy Title: Oregon's Health Insurance Coverage Holds Steady, but the State's Uninsured Rate Remains High Author: Jurjevich, Jason R., Byerly, Jack Year: 2012 Data released in August 2012 from the U.S. Census Bureau’s Small Area Health Insurance Estimates (SAHIE) program show that Oregon continues to have one of highest rates of uninsured residents in the U.S. According to Census estimates, 639,710 or 19.7 percent of Oregonians under age 65 were without health insurance coverage in 2010. For the under-65 population, Oregon’s uninsured rate ranks as the 15th highest rate in the country. Compared to 2009, the 2010 data show no statistically significant change in the overall uninsured rate for Oregon. Similarly, there were no statistically significant changes for Oregon between 2009 and 2010 by race/ethnicity or by income (Table 1). The highest rate of uninsured continue to be observed for Hispanic persons at 34.3 percent ( /- 1.3 percent) and for Oregonians earning 138% of the poverty level or less (34.7 percent [ /- 1.0 percent]). Title: Oregon's Health Insurance Coverage Holds Steady, but the State's Uninsured Rate Remains High Author: Jurjevich, Jason R., Byerly, Jack Year: 2012 Data released in August 2012 from the U.S. Census Bureau’s Small Area Health Insurance Estimates (SAHIE) program show that Oregon continues to have one of highest rates of uninsured residents in the U.S. According to Census estimates, 639,710 or 19.7 percent of Oregonians under age 65 were without health insurance coverage in 2010. For the under-65 population, Oregon’s uninsured rate ranks as the 15th highest rate in the country. Compared to 2009, the 2010 data show no statistically significant change in the overall uninsured rate for Oregon. Similarly, there were no statistically significant changes for Oregon between 2009 and 2010 by race/ethnicity or by income (Table 1). The highest rate of uninsured continue to be observed for Hispanic persons at 34.3 percent ( /- 1.3 percent) and for Oregonians earning 138% of the poverty level or less (34.7 percent [ /- 1.0 percent]). Close

• 4. [Article] The impact of Oregon’s Coordinated Care Organizations on Prenatal Care Access and Quality : A Difference-in-Differences Analysis

  Background: Prenatal care (PNC) is an important preventive health service that can influence the health of the four million women who give birth annually in the United States, and the health their infants. ...

  Citation × Citation Citation Abstract Copy Title: The impact of Oregon’s Coordinated Care Organizations on Prenatal Care Access and Quality : A Difference-in-Differences Analysis Author: Muoto, Ifeoma O. Background: Prenatal care (PNC) is an important preventive health service that can influence the health of the four million women who give birth annually in the United States, and the health their infants. Despite efforts to increase women’s access to PNC services, significant disparities in PNC utilization and maternal/child health outcomes by insurance type and race/ethnicity persist in the United States. The past decade has witnessed several major health reforms at both national and state levels. However, the impact of these reforms on the quality of PNC, and on disparities in PNC utilization is not known. In 2012, the state of Oregon established Coordinated Care Organizations (CCOs) as comprehensive providers of care for Oregon’s Medicaid beneficiaries. CCOs are characterized by a global budget payment mechanism and financial incentives for high quality care. Timely initiation of PNC – which has been associated with improved maternal and infant health and utilization outcomes – is one of seventeen quality metrics for which CCOs can receive incentive payments. Objectives: The first objective of the current study was to estimate the impact of CCO implementation on the probability of initiating PNC in the first trimester, and on PNC adequacy among Oregon Medicaid beneficiaries. The second objective of the study was to determine if the implementation of CCOs influenced disparities in PNC utilization between Medicaid and privately-insured women, and between non-Hispanic White women and Hispanic/non-Hispanic Black women. Study Design: This quasi-experimental retrospective observational study drew from two data sources: Oregon Vital Records (Birth Certificate statistical files) from the department of Health Analytics of the Oregon state public health department and Washington State’s Linked Birth- CHARS (Comprehensive Hospital Abstract Reporting System) data from the Washington State department of health. A difference-in-differences approach examined PNC utilization before and after CCO implementation. Washington State served as the control group, as its Medicaid financing and delivery systems remained unchanged. Multivariable linear probability analysis was used to control for confounding factors, including maternal age, race/ethnicity, education, parity, marital status, smoking history, previous preterm birth, and maternal morbidity. Population Studied: All births in Oregon and Washington from 2008 – 2013, which were covered by either Medicaid or private insurance, were included in the analysis. Since CCOs started operating mid-year in 2012, June through December 2012 was considered a transition period and births during this period were excluded from the analysis. Principal Findings: CCO implementation was associated with a significant increase in the probability of PNC initiation in the first trimester and a reduction in insurance-type disparities in first trimester PNC initiation and PNC adequacy among Oregon Medicaid beneficiaries. Racial/ethnic disparities did not change following CCO implementation. Conclusions: The implementation of CCOs in Oregon had a positive impact on the timeliness of PNC initiation among Medicaid beneficiaries, and also reduced disparities in PNC quality between Medicaid and privately-insured women. Implications for Policy or Practice: The ongoing health system transformation in Oregon provides an ideal setting to assess the impact of a novel health service delivery model on PNC utilization. If Oregon is successful in this bold and unprecedented move, it could serve as a model for other Medicaid and commercial health plans seeking to improve PNC quality. Further study on the longer-term effects of CCO implementation on PNC quality as well as the effect of CCOs on other health care domains, is warranted. Title: The impact of Oregon’s Coordinated Care Organizations on Prenatal Care Access and Quality : A Difference-in-Differences Analysis Author: Muoto, Ifeoma O. Background: Prenatal care (PNC) is an important preventive health service that can influence the health of the four million women who give birth annually in the United States, and the health their infants. Despite efforts to increase women’s access to PNC services, significant disparities in PNC utilization and maternal/child health outcomes by insurance type and race/ethnicity persist in the United States. The past decade has witnessed several major health reforms at both national and state levels. However, the impact of these reforms on the quality of PNC, and on disparities in PNC utilization is not known. In 2012, the state of Oregon established Coordinated Care Organizations (CCOs) as comprehensive providers of care for Oregon’s Medicaid beneficiaries. CCOs are characterized by a global budget payment mechanism and financial incentives for high quality care. Timely initiation of PNC – which has been associated with improved maternal and infant health and utilization outcomes – is one of seventeen quality metrics for which CCOs can receive incentive payments. Objectives: The first objective of the current study was to estimate the impact of CCO implementation on the probability of initiating PNC in the first trimester, and on PNC adequacy among Oregon Medicaid beneficiaries. The second objective of the study was to determine if the implementation of CCOs influenced disparities in PNC utilization between Medicaid and privately-insured women, and between non-Hispanic White women and Hispanic/non-Hispanic Black women. Study Design: This quasi-experimental retrospective observational study drew from two data sources: Oregon Vital Records (Birth Certificate statistical files) from the department of Health Analytics of the Oregon state public health department and Washington State’s Linked Birth- CHARS (Comprehensive Hospital Abstract Reporting System) data from the Washington State department of health. A difference-in-differences approach examined PNC utilization before and after CCO implementation. Washington State served as the control group, as its Medicaid financing and delivery systems remained unchanged. Multivariable linear probability analysis was used to control for confounding factors, including maternal age, race/ethnicity, education, parity, marital status, smoking history, previous preterm birth, and maternal morbidity. Population Studied: All births in Oregon and Washington from 2008 – 2013, which were covered by either Medicaid or private insurance, were included in the analysis. Since CCOs started operating mid-year in 2012, June through December 2012 was considered a transition period and births during this period were excluded from the analysis. Principal Findings: CCO implementation was associated with a significant increase in the probability of PNC initiation in the first trimester and a reduction in insurance-type disparities in first trimester PNC initiation and PNC adequacy among Oregon Medicaid beneficiaries. Racial/ethnic disparities did not change following CCO implementation. Conclusions: The implementation of CCOs in Oregon had a positive impact on the timeliness of PNC initiation among Medicaid beneficiaries, and also reduced disparities in PNC quality between Medicaid and privately-insured women. Implications for Policy or Practice: The ongoing health system transformation in Oregon provides an ideal setting to assess the impact of a novel health service delivery model on PNC utilization. If Oregon is successful in this bold and unprecedented move, it could serve as a model for other Medicaid and commercial health plans seeking to improve PNC quality. Further study on the longer-term effects of CCO implementation on PNC quality as well as the effect of CCOs on other health care domains, is warranted. Close