Ohio Medicaid to begin paying for quality, value in new managed care contracts

The Ohio Medicaid program announced yesterday that Ohio will be the first state in the nationa to work with a large private payer organization to develop contract language that ties managed care payment to quality outcomes (Source: “Ohio begins value-based measure for Medicaid,” Dayton Daily News, Jan. 9, 2012).

As Medicaid begins the rebidding process this month for 2013 contracts with managed care plans, it will be using language developed by Catalyst for Payment Reform to set some payments based on the value of care received by patients. CPR is a San Francisco-based nonprofit organization of large employers/health care purchasers such as General Electric Co., Walmart Corp. and The Dow Chemical Company.

The partnership with CPR will not cost the state any money and officials say they are still working to develop the quality and savings goals that will be used to measure managed care plans. 

In November, HPIO hosted CPR Executive Director Suzanne Delbanco and a panel of public and private purchases for a forum on opportunities for purchasers to drive health care value. HPIO also partnered with CPR to field test its Market Assessment Tool in Columbus. Columbus was one of three cities in the nation selected to test the tool, which is designed to gauge the readiness of a particular market for payment reform.

“We are encouraged that Ohio Medicaid is moving forward with efforts to tie payment to quality outcomes and value. This will encourage other public and private purchasers to leverage their ability to improve outcomes and lower costs,” said HPIO President Amy Rohling McGee. 

“Medicaid’s decision affirms the interest from public and private stakeholders that we heard both at our forum and in working with CPR on their assessment of the Columbus marketplace,” McGee added.  “HPIO looks forward to working with Ohio Medicaid and OPERS in discussions focused on aligning public and private payment with better health quality outcomes.”

HPIO adopted payment reform as one of its four strategic objectives in 2011 and is currently engaging public and private stakeholders in an ongoing payment reform collaborative. As part of this collaborative, this month HPIO will be hosting small groups of providers, purchasers, payers and consumer representatives to help move forward a collective agenda around payment reform.