Ohio Medicaid Managed Care Solution

Modern Medicaid Alliance Featured Medicaid Solution: Ohio Medicaid Managed Care

The Challenge:

For the state of Ohio, providing high-quality, affordable health care is a top priority. Under traditional fee-for-service (FFS) Medicaid, states contract with providers and pay a set fee for each service; therefore, providers are paid based on the volume of services rather than the value of those services. Ohio’s Medicaid expansion efforts expanded Medicaid eligibility while providing higher value care than traditional Medicaid.

Medicaid Solution:

Ohio’s shift to managed care has proven to be a successful strategy for expanding access to care while saving taxpayer dollars, improving quality, and spurring continued innovation in care delivery. Though the state has had Medicaid managed care since the 1970s, Medicaid managed care has increased in recent years especially after Medicaid expansion in 2013. Under Ohio’s Medicaid managed care program, the state of Ohio pays Medicaid managed care plans (MCPs) a fixed monthly rate. This rate covers specified services for members and holds health plans accountable for their members’ health by making them financially responsible to provide all health services agreed to with the Ohio Department of Medicaid (ODM).

Ohio’s managed care strategy is based upon three pillars – “delivering better care, contributing to healthy people and healthy communities, and practicing best evidence medicine across the care continuum” – that guide the various initiatives and quality measurements to improve care for residents. Managed care plans help align doctors and other providers to improve performance through collaboration in statewide innovation programs that address value-based purchasing, health crises like opioid abuse, and attending to the needs of special populations, such as pregnant women and infants.

Medicaid Results:

Medicaid managed care now covers 86 percent of all Medicaid enrollees in the state, roughly 2.5 million residents. Since 2008, Ohio Medicaid has added new categories of eligibility and expanded managed care to new populations. Managed care now covers more than 37,000 children with special needs, and 77 percent of Aged, Blind, and Disabled (ABD) individual enrollees.

In terms of taxpayer savings, managed care saved taxpayers 9 to 11 percent from2013 to 2015. That’s an estimated $2.5 to $3.2 billion in savings. Managed care has also proven effective in managing Ohio’s prescription drug benefit, resulting in Medicaid pharmacy cost savings: Ohio’s prescription costs were $3.70 per prescription below the national average with the nation’s 16th lowest costs per prescription in 2015.

As for health quality, Ohio delivers higher quality care. The National Committee for Quality Assurance (NCQA) recently released state average quality scores for 2016-2017, finding that Ohio managed care plans had higher quality scores than both the national average and other states like California, Florida, Illinois, New York, Pennsylvania, and Texas. Ohio’s managed care plans also performed well against national Medicaid benchmarks: Ohio MCPs reached the 75th percentile for ongoing prenatal care and postpartum care, comprehensive diabetes care (eye exams), follow-up after hospitalization for mental illness, and appropriate treatment of children with upper respiratory infections.

“Ohio is modernizing its Medicaid program by replacing an antiquated fee-for-service model with a system that better coordinates care and allows us to both measure and reward quality.” Barbara Sears, Ohio Medicaid Director