Earlier this week Ohio’s Office of Health Transformation provided a press release from Governor John Kasich noting that in January 2017, Ohio will launch a comprehensive primary care (CPC) program to allow the state's four largest private health insurance plans, along with Medicaid and Medicare, to pay for value rather than volume. Per the release: Beginning January 1, 2017, Ohio's largest health insurance plans, Medicaid and Medicare, will reward primary care providers that do more to keep patients well and hold down the total cost of care … together these programs create an unprecedented opportunity to give Ohioans the quality of care they need to increase their level of health at every stage of life.
The Ohio Comprehensive Primary Care (CPC) Program allows high-performing primary care practices to earn enhanced reimbursement from Medicaid and other participating health plans, and yesterday the Centers for Medicare and Medicaid Services announced that Medicare also will provide enhanced payments for select practices in Ohio through a similar program called Comprehensive Primary Care Plus (CPC+). The Ohio CPC program is designed to increase access to patient-centered medical homes (PCMH), a team-based care delivery model led by a primary care provider who comprehensively manages a patient's health needs with an emphasis on health care value and quality. Ohio was selected as one of 14 regions nationwide to participate in CPC+.
The details of the report indicate that the health insurance companies that are voluntarily participating for their private pay clients include Aetna, Anthem, Medical Mutual and UnitedHealthCare while the five managed care organizations include Paramount, Molina, Buckeye, CareSource and UnitedHealth Care.
Ohio has had as its goal to have 80% of its residents/population in a PCMH by 2017/2018. This goal is one that encourages LeadingAge Ohio to find opportunities for our members to play a more central role in the PCMH models. The LeadingAge Ohio Incubator Committee will be working on opportunities to pilot long-term care focused PCMH models. Please contact Nisha Hammel at nhammel@leadingageohio.org with questions.