Ohio Medicaid To Launch Patient-Centered Medical Homes In 2016

Ohio is preparing to launch the second component of its cross-payer health system reform project, a statewide patient-centered medical home (PCMH) model, in 2016. By December 2018, the Ohio Office of Health Transformation (OHT) anticipates that at least 80% of the state’s 11.5 million population across all payers including Medicaid, will be participating in a PCMH for primary care services.

To implement the Medicaid PCMH component, on May 27, 2015, the Ohio Department of Medicaid released a request for proposals (RFP 0A1154) seeking responses by June 22, 2015 from contractors with experience in designing PCMH programs and technical models, with multi-payer experience preferred. The contractor will provide project management, stakeholder engagement, research and analysis, PCMH design services, implementation, training, reporting, and program evaluation. The contract is slated to begin in July 2015. The initial contract term will run from the award date through June 30, 2017, followed by two optional two-year extension periods. The contract will be structured as a fixed price based on the vendor’s cost proposal. Proposals were submitted by McKinsey & Co., Inc.; Medical Advantage Group; Mercer; and The Health Collaborative. As of July 9, 2015, the state had not posted a contract award notice to the procurement site.

An OHT spokesperson said the cross-payer project is part of OHT’s larger initiative to engage the private sector to improve overall health system performance. During 2013, OHT was awarded a federal State Innovation Model (SIM) design grant, and in December 2014, the federal Centers for Medicare & Medicaid Services (CMS) awarded Ohio an implementation grant.

In planning its SIM project during 2013, OHT achieved multi-payer agreements across five Medicaid managed care organizations and the state’s four largest commercial health plans to design and launch retrospective episode-based payments for acute medical events and a statewide rollout of the PCMH model financially rewarding high value provider organizations. The participating commercial health insurers are Anthem, Aetna, Medical Mutual of Ohio, and UnitedHealthcare. The Medicaid MCOs are Buckeye, Caresource, Molina, Paramount, and UnitedHealthcare.