Policy Analysis: State Health Policy Reform Innovation

State Health Policy Reform Innovation
Student's Name
Institutional Affiliation
Abstract
The US healthcare policy is undergoing changes aimed at instilling proper cost management and efficiency. Part of the development is evident at the state levels. Different states have taken the initiative to steer their healthcare through the necessary quality and cost management practices. In 2012, Oregon became one of the states that fuel healthcare reform innovations. The Oregon policy is known as the coordinated care model and was sponsored by the state legislator. The policy intends to integrate Medicare utilization in the state. The coordinated care model was based on the state's modification of its Section 1115 Medicaid waiver. The terms of the waiver indicate that Oregon would receive $1.9 billion federal funds over five years to fuel the implementation of CCOs. Within that period, the state needed to reduce its Medicaid-per beneficiary spending growth by at least two percentage points two years after the implementation. Oregon renewed its federal government waiver in 2017. So far, the results are positive, with Oregon leading in various state-based comparative analyses of healthcare innovations.
Keywords: coordinated care, waiver, and Medicaid
State Health Policy Reform Innovation
The US healthcare system is currently undergoing an extensive change poised to make it better. Partly, the present changes are focused on some of the problems that healthcare faces presently, including high costs and lack of efficiency. Various state governments have implemented healthcare policies that will lead to lower costs for the patients and hospital management, better outcomes, and enhanced quality. Governors understand that improving health to their citizens is essential in balancing budgets and controlling healthcare costs as much as it is important in ensuring that citizens live productively. There is a wide range of state health reform innovations poised to change healthcare structures in different states in the future. Oregon is one of the states that have designed platforms to instill futuristic healthcare plans in the state. This policy analysis explores Oregon's coordinated care model policy through its different prospects, including its rationale, adoption, funding structure, impacts, and ethical considerations. The coordinated care model is a vital innovation that could be mirrored in other states in instituting improvements in the coordination of care in Medicaid.
Coordinated Care Model
Oregon introduced a policy to improve its coordination of care in Medicaid in 2012. The new policy would be referred to as the coordinated care model, and it revolved around the inputs of coordinated care organizations (CCO) (Kowalski, 2018). CCOs are state-created community–based and integrated care organizations. The organizations are majorly developed to help integrate healthcare activities through segments of the state's population included in the Oregon Health Plan. CCOs are a form of accountable organizations whose members are part of the Medicaid segment of the population. The Oregon Health Authority describes CCOs as a network of stakeholders in healthcare, including members of the general population and patients and local community groups, healthcare service providers, and hospitals (Huelskoetter, 2018). The stakeholders in CCOs have agreed to work together to integrate healthcare in different categories, including mental health care, addictions, and physical health care. The CCOs work with individuals who are beneficiaries of the Oregon Health Plan or Medicaid.
Oregon's coordinated care model is poised to accommodate as many people as possible. However, bearing the fact that it is still in the initial years of its operations, the policy is still gaining popularity. As of 2018, the CCOs covered about one million individuals segmented geographically. The state needed an even distribution of the CCOs through its key regions. There were 15 CCOs as of 2018. Most of the organizations within the program were initially managed care organizations before they were transformed to mirror the new model. Efforts are still instilled to ensure that more CCOs are developed depending on the strategic needs of the populations.
Adoption
The coordinated care model is motivated to achieve various objectives. The first objective is to instill innovative approaches to coverage expansion. Medicaid coverage is one of the challenges that states face in dealing with healthcare needs. The coordinated care model fosters expanding access to Medicaid for the deserving populations in Oregon (Kowalski, 2018). There's the inclusion of Medicaid expansion in the coordinated care model so that Oregon citizens find a healthcare structure that befits the people's goals and the state's political culture. Each state is different based on how they perceive healthcare, thereby warranting unique approaches in delivering healthcare initiatives.
The second objective of the coordinated care model is to foster data exchange to support and drive change. Establishing efficient platforms for sharing data among stakeholders is one challenge that still impedes healthcare efficiency (Baicker & Finkelstein, 2018). The coordinated care model noted that sharing among the state government, providers, and payers is the key to healthcare transformation. Presently, there are distorted data transfers among stakeholders, which hinders the scope of healthcare activities. Through CCOs and various integrated community groups, data collection can be eased, and more efficiency can be achieved among stakeholders (Katch, 2016). Such initiatives allow for better care coordination, integration of primary behavioral health and patient engagement, and population management. In the long run, such inputs are poised to reduce healthcare costs.
The coordinated care model also explores Medicaid payment and delivery systems. The Medicaid programs have proven complicated for some states. In an attempt to make significant changes in their programs, states have channeled federal funding to waiver Medicaid costs. Oregon's plan becomes efficient because it constitutes the individuals in need of the services before profiling individual needs (Kowalski, 2018). Transferring funds towards a specific course, hence, becomes simplified. This strategy also helps in leveraging the states purchasing power to accelerate reforms. Stakeholders such as healthcare insurance marketplaces, state employee's health benefit programs, and Medicaid programs significantly influence healthcare practices. Such influences can be used to fuel reforms bearing the value of the newly found collective bargain.
Ultimately, the coordinated care model emphasizes improving care for individuals with behavioral health issues. Individuals with behavioral health needs are constantly excluded in the healthcare initiatives that should trigger better patient outcomes (Baicker & Finkelstein, 2018). States are steadily changing the trends to assist with improved care for Medicaid beneficiaries with behavioral health needs. Some of the programs emphasized in the programs include substance use disorders, severe mental illnesses, and linked healthcare concerns wit...