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| Presented by: Holly Saelens, Vice President of Government Contracts
Managed Care Innovation Value Based Reimbursement in the Ohio Medicaid Program 6/29/2018 | Presented by: Holly Saelens, Vice President of Government Contracts
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The Molina Mission Our Vision Our Mission Core Values
We envision a future where everyone receives quality health care. Our Vision To provide quality health care to persons receiving government assistance. Our Mission Caring Enthusiastic Respectful Focused Thrifty Accountable Feedback One Molina Core Values
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Molina Healthcare of Ohio Snapshot
Health Plan Facts 338,000 members 1,079 employees 3 offices across Ohio Provider Network 21,929 primary care & specialist providers 313 hospitals 4,130 ancillary service providers Lines of Business Medicaid Medicare MyCare Ohio Medicare-Medicaid Health Insurance Marketplace Medicaid MyCare Ohio Medicare Marketplace Ashtabula Lake Geauga Trumbull Lucas Cuyahoga Ottawa Fulton Erie Lorain Portage Williams Sandusky Summit Mahoning Wood Huron Medina Henry Defiance Seneca Columbiana Stark Hancock Ashland Wayne Paulding Putnam Crawford Carroll Richland Wyandot Jefferson Holmes Van Wert Allen Morrow Tuscarawas Hardin Marion Harrison Knox Auglaize Coshocton Mercer Union Delaware Logan Belmont Guernsey Shelby Licking Champaign Muskingum Franklin Monroe Miami Noble Darke Clark Madison Perry Morgan Fairfield Montgomery Pickaway Washington Greene Preble Hocking Fayette Athens Warren Ross Vinton Clinton Butler Meigs Highland Jackson Hamilton Pike Clermont Gallia Scioto Brown Adams Lawrence
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Value-based Purchasing
Managed Care Drives Innovation Value-based Purchasing Well structured, value-based agreements increase access to care, raise health awareness, promote early detection, improve outcomes and reduce cost. Through these initiatives, providers are eligible to receive additional payments when they achieve a quality goal as outlined in their contract. While metrics may vary amongst plans, most MCPs apply similar metrics related to primary and preventive care and often utilize national quality standards. By 2020, all Medicaid managed care plans must link 50 percent of provider payment to value.
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Ohio SIM - Paying for Value
Ohio brings a team together: Focus on paying for value instead of volume. Partnership and standardization to include ODM, MCPs and private sector partners. Partners agree to align on 2 value models: Episodes of Care + Ohio CPC Align 50% of Molina’s Medicaid claims payment to value-oriented programs by 2020
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Ohio SIM - Paying for Value
Episodes of Care + Ohio CPC Episodes of Care Ohio Comprehensive Primary Care Retrospective Model Episodes growing in variety Upside-downside incentive payments 3 episodes in CY2016 17 providers penalized $134 to $29,036 29 providers rewarded $193 to $43,451 43 episodes starting CY2018 Launched 1/1/2017 Voluntary, population health focused PCPs must meet activity, efficiency and clinical metrics PMPM + Shared Savings Over 30% of Medicaid members impacted, nearing 50% by 1/1/2018 111 Practices participating with up to 91 additional in 2018 +
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Paying for Value
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Managed Care Plan Performance
Quality Withhold Program The Kasich Administration established a Quality Withhold Program in HB 49 to replace the P4P program. ODM will withhold 2% of the MCPs capitation and delivery payments beginning April 2018. ODM will use Quality Indices to calculate the amount of the withhold payout. Quality Indices are comprised of multiple performance measures related to the index topic. Quality Indices measure the effectiveness of the MCP’s population health management strategy and quality improvement programs to impact population health outcomes. Performance will be assessed on four equally weighted Quality Indices. The Quality Indices used in the Quality Withhold program for SFY 2019 (measurement year 2018) are: Each index is composed of multiple quality measures which are assigned different weights. Chronic Condition: Cardiovascular Disease Chronic Condition: Diabetes Behavioral Health Healthy Children
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Projected launch date July 1, 2018 (pending CMS approval)
CICIP- Overview for Managed Care Projected launch date July 1, 2018 (pending CMS approval) Purpose - to increase alignment of quality improvement strategies between ODM, MCP, and public/nonprofit hospital agencies. Focus - improve healthcare and coordination of care for members with opioid or other substance use disorders. Participants will receive a quality measure incentive for meeting the following metrics:
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CICIP - Overview for Managed Care
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