Ohio Medicaid Reform Targets Population Health Improvements
The State of Ohio is seeking to reinvent its Medicaid program by working more closely with managed care organizations (MCOs) on a population health strategy and streamlining administrative processes.
Approximately 3 million people — one in three Ohioans — are covered by Medicaid. A recent editorial in the Columbus Dispatch explained some of the background. It pointed to a 2019 report by the Health Policy Institute of Ohio that ranked the state 46th in health value. “Ohio is especially bad at ensuring that children and adolescents on Medicaid get the health care they need,” the Dispatch wrote. “Barely half of our children receive the well-child visits to which they’re entitled. Fewer than half receive dental care, and fewer than two-thirds get all the vaccinations they need.”
Currently, five managed care organizations divide up Ohio’s Medicaid business under contracts that have been in place since 2013. The state is seeking proposals for new contracts, and the “request for application” that went out recently makes new demands on potential MCOs.
The Ohio Department of Medicaid (ODM) lists five goals for the future:
• Improve wellness and health outcomes.
• Emphasize a personalized care experience.
• Support providers in better patient care.
• Improve care for children and adults with complex needs. Among the goals is providing high-intensity wrap-around services and supports for Ohio’s children and adolescents with complex behavioral health needs.
• Increase program transparency and accountability.
“We envision a managed care program in which ODM and the MCOs work together to tackle some of the toughest health challenges and disparities,” said Maureen Corcoran, director of ODM, when the request for applications went out. “We can achieve healthcare excellence by introducing a seamless service delivery system that works for members, providers, and community partners. Bidders will be assessed based on their ability and interest in partnering with ODM to achieve the goals of the future program.”
As part of the administrative simplification effort, ODM has issued a request for proposals (RFP) for a single pharmacy benefit manager (SPBM) across all five MCOs.
In 2019, the Ohio General Assembly mandated, and Gov. Mike DeWine signed into law, the selection of an SPBM in the state’s fiscal year 2020-2021 biennial budget. ODM said this strategy will ease provider administrative burdens, reduce operational costs, and strengthen the state’s fiscal oversight of this vital healthcare benefit. The department quotes Corcoran, as saying, “The Ohio Department of Medicaid is pleased with the number of responses to the RFP for a single pharmacy benefit manager. Change Healthcare, DXC Technology, Express Scripts, MagellanRx Management, Navitus Health Solutions, and RxAdvance each submitted responses. ODM now will use the review process to select the best candidate for those we serve and the Ohio taxpayer. These reforms are on pace to be implemented on schedule.”
The Dispatch editorial explained that some of the administrative simplification should “return control over the reams of data involved in Medicaid care to the state, making it easier for Medicaid officials to spot trends and analyze problems. It also will make it easier to see how much taxpayers are spending for those administrative functions. Having them built into each separate managed care organization’s contract and subcontracts allowed too much opportunity for the companies to hide and pad the associated fees.”
