Point-Counterpoint
Oregon's Coordinated Care Organizations Harold A. Pollack University of Chicago
Whenever Medicaid is mentioned, Oregon always seems to be at the center of attention and controversy. Two decades ago, Oregon’s efforts to prioritize expenditures through the systematic and public ranking of medical services created a storm of controversy, as well as worldwide debate over the morality and admin istrative feasibility of (at least supposed) rationing of services to control Medicaid expenditures (Oberlander, Marmor, and Jacobs 2001). Within the past year, the Oregon Health Insurance Experiment (OHIE) has made front-page news. In 2008, Oregon opened a waiting list for a lim ited number of low-income uninsured adults to receive Medicaid. State officials drew names by lottery from ninety thousand people who had signed up for a waiting list. This lottery structure made possible a rigorous randomized trial, within which one could explore the impact of Medicaid enrollment on health services use, physical and mental health, and the burdens of medical debt (Finkelstein et al. 2012). Most recently, OHIE hit the front pages with its finding that enrolling uninsured adults into Medi caid increased rates of emergency department use (Pollack 2014; Taubman et al. 2014). Delivery system innovations receive less attention than do issues of apparent rationing or expanded Medicaid access. Yet these are scarcely less important. Oregon’s coordinated care organizations (CCOs) represent one of the nation’s most ambitious efforts to improve quality and costeffectiveness while reducing expenditures through medical homes and improved coordination of care. Steven Howard, Stephanie Bernell, Jangho Journal o f Health Politics, Policy and Law, Vol. 39, No. 4, August 2014 DOI 10.1215/03616878-2744438 © 2014 by Duke University Press
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Journal o f H ealth Politics, Policy and Law
Yoon, and Jeff Luck’s Point essay enthusiastically supports these new arrangements, citing early indications that CCOs have reduced emergency department visits and hospitalizations. Eric Stecker’s Counterpoint is more skeptical, noting how the CCO experiment could founder.1 As we seek to address significant cost and quality challenges in Amer ican health care, much rides on the ability of innovations such as CCOs to overcome the inertia, fragmentation, and incentive pathologies embedded in fee-for-service models. As of this writing, the jury is out.
Harold A. Pollack is Helen Ross Professor o f Social Service Adm inistration at the University o f Chicago. He has been appointed to three expert committees o f the National Academies o f Sciences and is the president-elect o f the American Political Science Association's organized section on health politics and policy. His research has been published in th e American Journal o f Public Health, the Journal o f the American Medical Association, Health Economics, and other peer-reviewed publications. His journalism has appeared in the Washington Post, American Prospect, and other pub lications. In 2009 and 2010 he was a special correspondent fo r the New Republic's Treatm ent section, covering the health reform debate. He is the section editor fo r Point-Counterpoint.
R eferences
Finkelstein, A., S. Taubman, B. Wright, M. Bernstein, J. Gruber, J. P. Newhouse, H. Allen, K. Baicker, and the Oregon Health Study Group. 2012. “The Oregon Health Insurance Experiment: Evidence from the First Year.” Quarterly Journal o f Eco nomics 127, no. 3: 1057-106.
1. Given the organizational complexity o f CCOs, we recommend two additional working papers that provide further institutional and descriptive background. The papers are available on the ACA Implementation Research website. For supplementary reading to the Point article, see “Oregon’s Coordinated Care Organizations: Unique Healthcare Delivery Model or Just Managed Care by Another Nam e?” by Steven W. Howard, Stephanie L. Bemell, Jangho Yoon, Jeff Luck, and Claire M. Ranit (http://ssascholars.uchicago.edu/jhppl/content/oregon% E2% 80% 99s-coordinated-care -organizations-unique-healthcare-deiivery-m odel-or-just-m anaged-car). For the supplementary paper to the Counterpoint, see “ Oregon’s M edicaid Transformation: Early Observations on Var iations in Organizational Structure and Strategy” by Anna Marie Chang, Deborah J. Cohen, Dennis McCarty, Traci Rieckmann, and K. John McConnell (http://ssascholars.uchicago.edu/jhppl/content /oregon%E2%80%99s-medicaid-transformation-early-observations-variations-organizational-structure -and-).
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Oberlander J., T. Marmor, and L. Jacobs. 2001. “Rationing Medical Care: Rhetoric and Reality in the Oregon Health Plan.” Canadian Medical Association Journal 164, no. 11: 1583-87. Pollack, H. 2014. “Medicaid— and What Having It Means to ERs.” Healthinsurance.org (blog), January 2. www.healthinsurance.org/blog/2014/01/02/medicaid -and-what-having-it-means-to-ers. Taubman S., H. Allen, B. Wright, K. Baicker, and A. Finkelstein. 2014. “Medicaid Increases Emergency-Department Use: Evidence from Oregon’s Health Insurance Experiment.” Science 343, no. 6168: 263-68.
Copyright of Journal of Health Politics, Policy & Law is the property of Duke University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Oregon's Coordinated Care Organizations Harold A. Pollack University of Chicago
Whenever Medicaid is mentioned, Oregon always seems to be at the center of attention and controversy. Two decades ago, Oregon’s efforts to prioritize expenditures through the systematic and public ranking of medical services created a storm of controversy, as well as worldwide debate over the morality and admin istrative feasibility of (at least supposed) rationing of services to control Medicaid expenditures (Oberlander, Marmor, and Jacobs 2001). Within the past year, the Oregon Health Insurance Experiment (OHIE) has made front-page news. In 2008, Oregon opened a waiting list for a lim ited number of low-income uninsured adults to receive Medicaid. State officials drew names by lottery from ninety thousand people who had signed up for a waiting list. This lottery structure made possible a rigorous randomized trial, within which one could explore the impact of Medicaid enrollment on health services use, physical and mental health, and the burdens of medical debt (Finkelstein et al. 2012). Most recently, OHIE hit the front pages with its finding that enrolling uninsured adults into Medi caid increased rates of emergency department use (Pollack 2014; Taubman et al. 2014). Delivery system innovations receive less attention than do issues of apparent rationing or expanded Medicaid access. Yet these are scarcely less important. Oregon’s coordinated care organizations (CCOs) represent one of the nation’s most ambitious efforts to improve quality and costeffectiveness while reducing expenditures through medical homes and improved coordination of care. Steven Howard, Stephanie Bernell, Jangho Journal o f Health Politics, Policy and Law, Vol. 39, No. 4, August 2014 DOI 10.1215/03616878-2744438 © 2014 by Duke University Press
930
Journal o f H ealth Politics, Policy and Law
Yoon, and Jeff Luck’s Point essay enthusiastically supports these new arrangements, citing early indications that CCOs have reduced emergency department visits and hospitalizations. Eric Stecker’s Counterpoint is more skeptical, noting how the CCO experiment could founder.1 As we seek to address significant cost and quality challenges in Amer ican health care, much rides on the ability of innovations such as CCOs to overcome the inertia, fragmentation, and incentive pathologies embedded in fee-for-service models. As of this writing, the jury is out.
Harold A. Pollack is Helen Ross Professor o f Social Service Adm inistration at the University o f Chicago. He has been appointed to three expert committees o f the National Academies o f Sciences and is the president-elect o f the American Political Science Association's organized section on health politics and policy. His research has been published in th e American Journal o f Public Health, the Journal o f the American Medical Association, Health Economics, and other peer-reviewed publications. His journalism has appeared in the Washington Post, American Prospect, and other pub lications. In 2009 and 2010 he was a special correspondent fo r the New Republic's Treatm ent section, covering the health reform debate. He is the section editor fo r Point-Counterpoint.
R eferences
Finkelstein, A., S. Taubman, B. Wright, M. Bernstein, J. Gruber, J. P. Newhouse, H. Allen, K. Baicker, and the Oregon Health Study Group. 2012. “The Oregon Health Insurance Experiment: Evidence from the First Year.” Quarterly Journal o f Eco nomics 127, no. 3: 1057-106.
1. Given the organizational complexity o f CCOs, we recommend two additional working papers that provide further institutional and descriptive background. The papers are available on the ACA Implementation Research website. For supplementary reading to the Point article, see “Oregon’s Coordinated Care Organizations: Unique Healthcare Delivery Model or Just Managed Care by Another Nam e?” by Steven W. Howard, Stephanie L. Bemell, Jangho Yoon, Jeff Luck, and Claire M. Ranit (http://ssascholars.uchicago.edu/jhppl/content/oregon% E2% 80% 99s-coordinated-care -organizations-unique-healthcare-deiivery-m odel-or-just-m anaged-car). For the supplementary paper to the Counterpoint, see “ Oregon’s M edicaid Transformation: Early Observations on Var iations in Organizational Structure and Strategy” by Anna Marie Chang, Deborah J. Cohen, Dennis McCarty, Traci Rieckmann, and K. John McConnell (http://ssascholars.uchicago.edu/jhppl/content /oregon%E2%80%99s-medicaid-transformation-early-observations-variations-organizational-structure -and-).
Pollack ■ Point-C ounterpoint
931
Oberlander J., T. Marmor, and L. Jacobs. 2001. “Rationing Medical Care: Rhetoric and Reality in the Oregon Health Plan.” Canadian Medical Association Journal 164, no. 11: 1583-87. Pollack, H. 2014. “Medicaid— and What Having It Means to ERs.” Healthinsurance.org (blog), January 2. www.healthinsurance.org/blog/2014/01/02/medicaid -and-what-having-it-means-to-ers. Taubman S., H. Allen, B. Wright, K. Baicker, and A. Finkelstein. 2014. “Medicaid Increases Emergency-Department Use: Evidence from Oregon’s Health Insurance Experiment.” Science 343, no. 6168: 263-68.
Copyright of Journal of Health Politics, Policy & Law is the property of Duke University Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
