The Ohio Department of Medicaid (ODM) provides care to nearly 3 million Ohioans—including more than 1.2 million children and about 36,000 kids in the foster care system. Current performance for key measures in the pediatric Healthcare Effectiveness Data and Information Set (HEDIS) highlight Ohio’s status in the 25-50th percentile across a wide range of childhood health metrics. Ohio strives to take a strong step forward in improving the health of Ohio’s children.
The strategy of connecting every child to a patient-centered medical home holds promise for accelerating health improvements. Pediatricians have long understood the need for coordinating care and developed the original patient-centered medical home framework. Ohio has invested in this type of framework through the Comprehensive Primary Care (CPC) program, which offers additional financial incentives to providers to improve access and quality. While CPC serves as a good foundation for this work, refining the model to focus on children may help accelerate children’s health improvements. CPC practices that meet additional criteria can receive a bonus for controlling total cost of care. CPC serves as a good foundation to improve children’s health, but it is not enough.
Over the coming biennium, Ohio Medicaid will collaborate with primary care physicians who care for kids and Medicaid managed care plans to work toward improvements in childhood wellness and population health management. The agency will partner with medical practices that serve children, and participate in Medicaid’s CPC program to enhance outreach to families to receive needed services and facilitating visits by helping with scheduling and eliminating transportation barriers; incentivize alternative settings of care, including schools, through alternative payment models and investments in telehealth services; and to provide services to families with children who have not received needed care. The CPC payment model can support activities that drive poor outcomes, facilitating the provision of telehealth services, maintenance of eligibility, and addressing social determinants of health that contribute to unnecessary disparities in health outcomes.
All practices participating in the CPC program in 2020 that have at least 150 claims-based attributed members under age 21 as determined by ODM will be eligible and may elect to participate in CPC for Kids. Three additional quality metrics will be linked to payment for participating practices—lead screening, immunization for children, and immunization for adolescents. These practices will also receive information about tobacco cessation for children ages 12-17 and fluoride varnish application.
CPC for Kids practices will receive an additional $1 per member per month for each attributed patient age 20 and under beginning in January 2020, in addition to the CPC payment for these members as determined by risk tier. A lump sum payment will be awarded in late 2021 to the top-performing CPC for Kids practices in the 2020 performance year, in addition to any shared savings payments or bonus payments awarded to a practice for performance in the CPC program. Up to $2 million in bonus payments will be awarded for high performance related to behavioral health integration, foster care integration, transitions of care, school-based care integration, and measure screening performance.
Additional details about CPC program updates are available on the ODM website.