Integrated Care Delivery System (ICDS)- Ohio
Program Location:
Cleveland, OH
Payer Type:
Medicare
Medicaid
Parent Program:
Payers:
Medicaid
Medicare
Aetna
CareSource
United Healthcare
Molina
Buckeye Community Health Plan
Reported Outcomes
Description:
Ohio signed a Memorandum of Understanding with CMS on 12/11/2012. In collaboration with CMS, Ohio will extend coordinated care to its dual eligible population through an Integrated Care Delivery System (ICDS). The Integrated Care Delivery System (ICDS) is a system of managed care plans selected to coordinate the physical, behavioral, and long-term care services for individuals over the age of 18 who are eligible for both Medicaid and Medicare. This includes people with disabilities, older adults and individuals who receive behavioral health services. Ohio’s ICDS is called “MyCare Ohio.”
The MyCare Ohio approach is centered on the individual to effectively coordinate their care based on their specific needs. This care team includes: the individual, the individual’s family/caregiver, the MyCare Ohio plan care manager, the waiver service coordinator (if appropriate), the primary care provider, specialists, and other providers as applicable. Ohio selected five managed care plans, through a competitive process, to comprehensively manage the full spectrum of Medicaid and Medicare benefits.
The benefit package includes all benefits available through the traditional Medicare and Medicaid programs, including long-term care services and supports and behavioral health services. In addition, MyCare Ohio managed care plans may elect to include additional services in their benefit packages.
The demonstration continues for a 3-year period and ends on December 31, 2017.
Payment Model:
Medicare and Medicaid will each contribute to the total capitation payment consistent with baseline spending contributions. Demonstration savings percentages assume that ICDS Plans are responsible for the full range of services covered under the Demonstration. Aggregate savings percentages will be applied equally to the Medicaid and Medicare A/B components. Both CMS and the State will contribute to the methodologies used to develop their respective components of the overall blended rate. For information on the demonstration's payment model, review Appendix 6 of the approved CMS agreement.
Fewer ED / Hospital Visits:
Inpatient admissions, both overall and for ambulatory care-sensitive conditions, were lower for the demonstration eligible population versus a matched comparison group.
The demonstration resulted in a 21.3 percent reduction in inpatient admissions, a 14.3 percent reduction in the probability
of ambulatory care sensitive condition (overall) admissions, a 13.2 percent reduction in the probability of ambulatory care sensitive condition (chronic) admissions, and a 15.3 percent reduction in skilled nursing facility admissions.
Improved Patient/Clinician Satisfaction:
Most MyCare Ohio enrollees responding to the CAHPS survey gave their MMPs high ratings. Nearly all respondents felt that their personal doctors understood how their health problems affected their everyday lives, and most had the same doctor prior to enrolling in MyCare Ohio.
Improved Access:
Of the more than 100,000 Medicare-Medicaid enrollees eligible for MyCare Ohio, approximately 69,000 had enrolled in the capitated model demonstration as of December 2016.
Cost Savings:
MyCare Ohio plan staff reported cost savings from reductions in hospital admissions, readmissions, and use of skilled nursing facility and emergency department services. However, State officials did not have data on cost savings.
Last updated March 2019
