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Accountability and transparency took center stage in Oregon as the state began the work of redesigning the health care delivery system from a system that rewards volume to one that rewards value. State policy makers recognized that with the right tools the state could lead the market as a purchaser, but leading health system transformation required developing an outcomes-based system of accountability that included improved measurement systems, the right metrics, and transparency. Equally important was a meaningful incentive structure aimed at pushing the delivery system toward the kinds of outcomes the state was looking to achieve. A system of measurement would need to answer the question at the center of Oregon’s reform efforts, “Are we making progress toward better care, better health and lower per capita costs?” This chapter describes the process, approach, and methodology used by the state in developing a system of measurement, metrics, and incentive payments that serves as an essential underpinning of Oregon’s Medicaid health system transformation. |
