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Structural competency is an emerging framework for teaching health disparities from a systems-level perspective. A group of medical students piloted a peer-taught course on applying structural competency to patient care. Measuring the impact of educational innovations is critical, yet no literature quantitatively assessing structural competency curricula currently exists for the medical school setting. Students adapted an existing cultural competency assessment instrument to create the Clinical Structural Competency Questionnaire, a 52-item Likert-based survey tool. This tool was used to assess students’ self-reported knowledge, skills, and attitudes before, immediately after, and 6 months after the course. Data were analyzed using the Wilcoxon signed-rank test. Response proportion immediately after the course was 84% (n = 114). Of these, 34% (n = 39) could be matched for all survey time-points. Students reported increases in knowledge of structural competency (p

Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon’s Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment. Future research is needed to further understand the implications of these changes.

In 2012, Oregon initiated a significant transformation of its Medicaid program, catalyzed in part through an innovative arrangement with the Centers for Medicare and Medicaid Services (CMS), which provided an upfront investment of $1.9 billion to the state. In exchange, Oregon agreed to reduce the rate of Medicaid spending by 2 percentage points without degrading quality. A failure to meet these targets triggers penalties on the order of hundreds of millions of dollars from CMS. We describe the novel arrangement with CMS and how the CCO structure compares to Accountable Care Organizations (ACOs) and managed care organizations (MCOs).