Medicaid programs across the country have implemented initiatives to enhance primary care capabilities. An official with Ohio Medicaid recently described how the state’s Comprehensive Primary Care (CPC) program integrates with other efforts to support value-based purchasing and population health strategies in the Buckeye State.
Mylynda Drake, M.P.H., alternative payment model administrator at the Ohio Department of Medicaid, said Comprehensive Primary Care fits in well with other efforts and with the future direction of Ohio Medicaid, integrating the social and cultural framework into population health strategies. “For many of our populations, in Appalachia, in Amish country, or refugee populations, and others who don't necessarily fit our standard framework, we try to work with providers to develop community-specific frameworks that do fit the patient profiles for the communities they are located in,” she said.
Drake was speaking during a recent webinar hosted by the Center for Health Care Strategies, which works to support high-quality and equitable care, particularly for people served by Medicaid. She has been with Ohio Medicaid for nine years and has had several roles including involving data analysis and clinical quality metrics development and evaluation. Drake oversees Ohio's Comprehensive Primary Care program, the maternal and infant support programs, Integrated Care for Kids program and other value-based purchasing efforts. “Our main goals for our program overall are advancing health equity, driving comprehensive patient-centered care, and promoting affordability and sustainability,” she said.
Drake said Ohio Medicaid uses population health activities such as integrating behavioral healthcare, screening for social determinant needs, and using team-based care deliver, to better inform how to care for patients, as well as using quality and utilization metrics and tying those to per-member per-month dollars and incentive payments. “In order to be in our Comprehensive Primary Care program as a practice, they all have to agree to support those population health activities and attest to doing those throughout their performance year,” she explained.
The practices agree to be monitored on all of their quality and utilization metrics quarterly and get an annual report. For doing that, they get a per-member per-month payment during their performance year and are eligible to receive additional incentive payments depending on their performance. “Currently, in CPC, we do some continuous improvement work with our practices using quality improvement science trying to build capacity for new work in this space,” she said. “We get a lot of questions, for example, about school-based health opportunities, behavioral health integration opportunities, and how to work better with our managed care organizations in Ohio. Since we are a 90-plus percent managed care state, trying to figure out how to leverage those relationships, especially in regard to things like care coordination and data sharing, is where managed care organizations and primary care practices can really work together to best take care of patients.”
Ohio Medicaid also has a focus on maternal health and wellness. “We are working on creating a comprehensive maternal care program for OB/GYN practices that will mirror our CPC programs in regard to supporting population health activities,” Drake explained. “We are creating a kind of population health model for our OB/GYN practices that could then link directly to our primary care practices to ensure that longitudinal care for women and for their babies throughout their life while they're on Medicaid,” she added.
In the CPC for Kids program, Ohio Medicaid is working with the state’s Children's Initiative Office to coordinate and align the state's children's programming between Medicaid, Department of Health, Mental Health and Addiction Services, Department of Education, developmental disabilities and other programs. “We are trying to advance policy and innovation in our children's programming from birth through kindergarten,” Drake said, “and we are providing support services for all children and their families throughout our executive branch and our state network.” She described CPC for Kids as a nested model. “All of our practices in our CPC for Kids product line are also in our CPC program. It provides additional incentive payments and opportunities in exchange for agreeing to be monitored for some specific children's quality metrics and performing some pediatric-focused population health activities.”
Drake described efforts to streamline and modernize the state’s CPC program. “We are working with CMMI on Primary Care First (PCF) implementations. We have begun working on our state plan and working with our actuary to talk about how we might be able to integrate that PCF model into our existing CPC framework in order to update our program to support CMMI efforts,” she said. “As well as measure refinement, we're doing some work with CMMI as well on how to be able to collect electronic clinical quality measures specific to the Medicaid space to replace the administrative and claims- based measures we're currently using.”
Finally, the state is working on a collaborative approach to embedding health equity and to modernize managed care. “We're calling it the next generation of managed care and we begin new contracts with new managed care plans on July 1 that incorporate a lot more health equity principles than our previous contracts," Drake said. "We want to continue learning and growing, continue to get more patient feedback and expanding opportunities for patient input, and providing support to community providers and connections to primary care to better serve Medicaid patients.”