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Coordinated Care Organizations and mortality among low-income infants in Oregon
Linh N Bui1,2, Jangho Yoon1,2, S Marie Harvey1,2
1College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.
Insights
Oregon's Coordinated Care Organizations (CCOs) reduced infant mortality by 56% for Medicaid enrollees. This accountable care model showed greater benefits for preterm infants and increased effectiveness over time.
Area of Science:
- Public Health
- Health Services Research
- Perinatal Epidemiology
Background:
- Oregon implemented Coordinated Care Organizations (CCOs) in 2012 as an accountable care model for Medicaid enrollees.
- Understanding the impact of such healthcare reforms on vulnerable populations, like infants, is crucial for public health policy.
Purpose of the Study:
- To evaluate the effect of Oregon's CCOs on neonatal and infant mortality rates.
- To assess the differential impact of CCOs on preterm versus full-term infants.
- To analyze the temporal trends in CCOs' effectiveness on infant mortality.
Main Methods:
- Utilized a difference-in-differences probit model.
- Analyzed linked Oregon birth and death certificates with Medicaid/CCO enrollment data (2008-2016).
- Compared pre-CCO (2008-2011) and post-CCO (2012-2015) birth cohorts, adjusting for covariates.
Main Results:
- The CCO model was associated with a 56% reduction in infant mortality among Medicaid enrollees.
- Infant mortality reductions were more pronounced for preterm infants compared to full-term infants.
- The positive impact of CCOs on infant mortality increased in magnitude over the post-implementation period.
Conclusions:
- The Oregon CCO model demonstrated a significant reduction in infant mortality within the first year of life for Medicaid-enrolled infants.
- Accountable care models like CCOs show promise in improving perinatal health outcomes.
- The findings support the continued evaluation and potential expansion of integrated care models.
Objective:
To examine the impact of Oregon's Coordinated Care Organizations (CCOs), an accountable care model for Oregon Medicaid enrollees implemented in 2012, on neonatal and infant mortality.
Data Sources:
Oregon birth certificates linked with death certificates, and Medicaid/CCO enrollment files for years 2008-2016.
Study Design:
The sample consisted of the pre-CCO birth cohort of 135 753 infants (August 2008-July 2011) and the post-CCO birth cohort of 148 650 infants (August 2012-December 2015). We used a difference-in-differences probit model to estimate the difference in mortality between infants enrolled in Medicaid and infants who were not enrolled. We examined heterogeneous effects of CCOs for preterm and full-term infants and the impact of CCOs over the implementation timeline. All models were adjusted for maternal and infant characteristics and secular time trends.
Principal Findings:
The CCO model was associated with a 56 percent reduction in infant mortality compared to the pre-CCO level (-0.20 percentage points [95% CI: -0.35; -0.05]), and also with a greater reduction in infant mortality among preterm infants compared to full-term infants. The impact on mortality grew in magnitude over the postimplementation timeline.
Conclusions:
The CCO model contributed to a reduction in mortality within the first year of birth among infants enrolled in Medicaid.
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