Coordinated Care Organizations and mortality among low-income infants in Oregon

Abstract

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.