Ohio to participate in state, federal primary care payment initiatives

Separate state and federal initiatives announced this week aim to reform healthcare payments to encourage better primary care (Source: “Largest Ohio insurers to pay family doctors more under plan,” Columbus Business First, Aug. 4, 2016).

The Governor’s Office of Health Transformation announced that it will launch a statewide initiative next year in which Ohio's four largest commercial insurers and the private plans that manage most Medicaid patients will pay more to primary care doctors practicing preventative care under a state plan developed with an Affordable Care Act grant. 

The commercial insurers – Anthem Blue Cross and Blue Shield in Ohio, Aetna Inc., Medical Mutual of Ohio and UnitedHealthcare of Ohio – are voluntarily adopting the new payment models. They helped design the plan alongside state Medicaid officials and the state’s Medicaid managed care plans: CareSource, Molina Healthcare Inc., Buckeye Community Health Plan and Paramount Advantage. UnitedHealth has both commercial and Medicaid plans in Ohio.

Starting Jan. 1, qualified practices will get monthly per-patient payments for reducing medical claims by keeping patients well; they'll be measured on such factors as performing preventative care, following up after a hospital stay, and offering same-day visits and extended hours.

Also this week, the Centers for Medicare and Medicaid Services announced that Ohio is one of just 14 regions selected to participate in a separate federal program called Comprehensive Primary Care Plus, or CPC+, Medicare's far-reaching program promoting the use of patient-centered medical homes at primary care practices (Source: “CMS Identifies 14 CPC+ Regions, Starts Enlisting Primary Care Practices,” HealthLeaders Media, Aug. 3, 2016).

CPC+ is slated to run over a five-year period beginning in January 2017.