By: Ohio Department of Medicaid
The spring 2017 issue of The Ohio Family Physician is dedicated to help better understand several new quality-based payment programs, how they impact the way we deliver care, and how we get paid for providing that care.
The following feature from the issue gives details on the Ohio Comprehensive Primary Care (Ohio CPC) program and the differences between the Ohio program and the Medicare Comprehensive Primary Care Plus (CPC+) program. Look for other value-based payment features in upcoming editions of the Weekly Family Medicine Update, on the OAFP website, and on the Academy’s Facebook and Twitter pages.
The Ohio Department of Medicaid has joined the Governor’s Office of Health Transformation to engage public and private sector partners in designing a new health care delivery payment system that rewards the value of services—not the volume. Ohio, in working with the state’s four largest private health insurance plans, along with Medicaid and Medicare, has taken major steps towards creating a national model that will incentivize primary care physicians and other health care professionals to do more to keep patients well and hold down the total cost of care.
Ohio is engaged in several payment reform efforts. One example is the Ohio CPC program launched in January 2017 to allow payment for value rather than volume for high performing primary care practices across the state. Ohio CPC is a patient-centered medical home program, which is a team-based care delivery model led by a primary care practice that comprehensively manages a patient’s health needs.
Medicare will provide enhanced payments for select primary care practices in Ohio through a similar program called CPC+, which also began January 1, 2017. The Ohio CPC program is highly aligned with Medicare CPC+ in terms of payment streams, eligibility requirements, and program requirements.
- A minimum of 5,000 attributed Medicaid individuals and accreditation by one of the following: the Accreditation Association for Ambulatory Health Care; the Joint Commission, National Committee for Quality Assurance; or the Utilization Review Accreditation Commission
- A practice with 500 or more attributed Medicaid individuals determined through claims-only data at each attribution period and NCQA III accreditation
- Medicare CPC+ enrolled practices with more than 500 Medicaid members.
For practices interested in applying to participate in 2018, there will be no accreditation requirement, and a practice need only to meet the minimum 500 Medicaid lives.
The goal is to empower practices to deliver the best care possible to their patients, both improving quality of care and lowering costs. Most medical costs occur outside of a primary care practice, but primary care physicians and other health care professionals can guide many decisions that impact those broader costs, improving cost efficiency and care quality.
- Per member, per month payment to support activities required by the Ohio CPC program
- Shared savings payment to reward practices for lowering overall total cost of care.
Additionally, joining the Ohio CPC program gives practices access to data and reports that provide actionable, timely information needed to make better decisions about outreach, care, and referrals.
Ohio is excited about the advantage that comes with the alignment of the Ohio CPC program and Medicare’s CPC+ program.
For more information about Ohio’s payment reform initiatives, visit the Governor’s Office of Health Transformation website. For more physician-specific details about Ohio’s CPC program, visit the Ohio Department of Medicaid Comprehensive Primary Care page. You can learn more about CPC+ on the Centers for Medicare and Medicaid Services website.