In 2012 Oregon launched an ambitious redesign of its Medicaid program. It created a statewide network of coordinated care organizations, which are similar in some respects to accountable care organizations, but these coordinated care organizations get global, risk-adjusted budgets from the state, are responsible for a broad range of services (behavioral, dental, and physical), and are governed by a broad range of local stakeholders. The coordinated care organizations have implemented a number of innovations, including the following:

• Locating behavioral health specialists in primary care settings

• Using community health workers

• Using emergency department navigators to connect patients with primary care

• Emphasizing identification and brief treatment of substance abusers

How has this program worked? Per-member per-month spending for hospital care decreased sharply, and spending on primary care increased sharply. Most of the quality measures with incentives attached have improved. Most without incentives have not.

Discussion Questions

• Why should a state provide Medicaid to its citizens?

• Who is eligible for Medicaid in Oregon?

• How does this situation differ from eligibility in your state?

• How is Oregon’s Medicaid different from your health insurance? From Medicare?

• What type of insurance is Oregon Medicaid?

• Why might community health workers improve outcomes and save money?

• Why does Medicare not pay for community health workers?

• How might linking behavioral health and primary care improve outcomes and save money?

• How might connecting patients with primary care improve outcomes and save money?

• Is there evidence that good primary care improves outcomes and saves money?

• How might increasing treatment of substance abusers improve outcomes and save money?

• Is reducing the hospitalization rate a good thing?

• Is reducing use of emergency departments a good thing?