The Ohio Department of Medicaid (ODM) is seeking physicians and other health care professionals who are interested in offering feedback on 12 episodes of care in its statewide episode-based payment model.
- Cardiac valve
- Coronary artery bypass graft (CABG)
- Congestive heart failure (CHF) exacerbation
- Otitis media
- Tonsillectomy
- Pediatric acute lower respiratory infection (LRI)
- Headache
- Low back pain (LBP)
- Diabetic ketoacidosis (DKA)
- Hysterectomy
- Pancreatitis
- Skin and soft tissue infections.
During a comment session at the ODM in the first half of November, Medicaid will provide an overview of each episode and gather feedback from physicians and other health care professionals in a small group discussion. Prior to the meeting, ODM will provide all of the final logistical details and expectations for feedback, and send out any materials for review in advance. They would like to get at least 15-20 unique perspectives per episode. Design changes will be shared along with future reports.
If you are interested, or know a physician who may be interested, please contact Executive Vice President Ann Spicer with an email address where you can be reached and the episode(s) of interest. Ms. Spicer will relay that information to the ODM and the ODM will subsequently reach out to you with a formal invite.
In December 2014, Ohio was awarded a federal State Innovation Model (SIM) test grant to implement an episode-based payment model statewide. An episode payment is a single price for all of the services needed by a patient for an entire episode of care. The goal is to reduce the incentive to overuse unnecessary services within each episode, and give physicians and other health care professionals the flexibility to decide what services should be delivered, rather than being constrained by fee codes and amounts.