On March 16, Ohio Academy of Family Physicians Executive Vice President Ann Spicer attended the physician associations’ quarterly meeting with Ohio Department of Medicaid Director John McCarthy during which Karen Hoyt provided an Ohio patient-centered medical home (PCMH) program overview covering everything from population and services included in the PCMH model to practice eligibility, member attribution, and payment streams.
As part of the state innovation model (SIM) grant, Ohio intends to rollout statewide spread of PCMH to be fully functional in 2018 (the idea of staged regional rollout has been dropped). According to the Office of Health Transformation timeline, the PCMH program and payment model design will be completed in 2016. Physician and other health care professional education and enrollment will occur in 2017 for a fully functioning PCMH program with payment in 2018.
Generally speaking and subject to change, the PCMH model will be one model in which all practices participate (not a continuum of stages along a transformation process). The program will be designed to encourage practices to improve how they deliver care to their patients over time.
It is anticipated that in order to join the program, practices will have to submit an application and meet specific enrollment requirements. Once all details are finalized, Medicaid will use the various physician organizations, including the OAFP, to publicize the program and process.
- Being recognized as a state-designated PCMH – essentially a branding benefit
- Access to data to inform that practice’s decisions on outreach, care, and referrals.
- Per member per month (PMPM) payments to compensate practices for activities that improve care and that are currently undercompensated or uncompensated
- Quality and financial outcomes-based payment (shared savings) for achieving total cost of care savings and meeting pre-determined quality targets.
Additionally, some practices may also be eligible for one-time practice transformation support to help them begin a successful transition to the PCMH model.
Requirements to earn payments will include a set of six standard process requirements, a set of six standard activity requirements, a set of 20 clinical quality measures and a set of four to eight efficiency measures. Details relative to requirements are still being developed.
The OAFP will continue to provide updates on statewide spread of this PCMH program. Watch future editions of the Weekly Family Medicine Update and other OAFP communication vehicles for additional information and resources.