Ohio – Medical Homes
In 2010, the 128th Ohio General Assembly unanimously enacted Substitute House Bill 198, establishing a patient-centered medical home (PCMH) education advisory group tasked with implementing and administering a PCMH education pilot project. The first phase (planning and practice selection) of the pilot is complete, and the state announced in January 2012 that it would provide $1 million to support workforce training in pilot practices. The pilot includes 47 practices affiliated with four specific medical schools or five specific nursing schools, seven of which are led by nurse practitioners (exceeding the statutory requirement of four). While reviewing applications for participation, the advisory group was required to consider the percentage of a practice’s patients who are part of a medically underserved population, including Medicaid recipients.
Additionally, the advisory group will work with all medical and nursing schools in the state to develop new medical home curricula for medical students, advanced practice nursing students, and primary care residents. The legislation further stipulates that the project cannot require patients to receive a referral from a participating physician to receive specialist care, unless otherwise required by law.
The advisory group is required to submit findings and recommendations six months, one year, and two years after the first funding for the pilot is released. Furthermore, the law added three additional duties specific to medical homes to the Health Care Coverage and Quality Council within the Ohio Department of Insurance; however, the Department of Insurance has since disbanded the council.
More information on the Ohio pilot can be found in the advisory committee’s final work product report.
- The Cincinatti-Dayton region (including areas of Ohio and Kentucky) is one of seven markets participating in CMS’s Comprehensive Primary Care Initiative (CPCi). In this multi-payer initiative, Medicare is collaborating with public and private insurers in the selected states or regions with the goal of strengthening primary care. CPCi launched in November 2012, bringing together ten payers in Ohio and Kentucky, as well as 75 participating primary care practices with 276 providers across the region.
- On September 17, 2012, the Centers for Medicare & Medicaid Services (CMS) approved a Section 2703 health home state plan amendment for Medicaid enrollees with chronic conditions. The SPA targets patients with serious and persistent mental illness served by community behavioral health centers in five counties. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
- HealthBridge, serving the greater Cincinnati area (including parts of Kentucky and Indiana), has received a Beacon Community Grant.
Last Updated: April 2014
PCMH Education Pilot Project: Substitute House Bill 198 (128thGeneral Assembly) established an eighteen-member patient-centered medical home (PCMH) education advisory group. Membership statutorily includes:
Non-voting, ex officio:
The advisory group also hosted a statewide webinar and four regional town hall meetings to educate prospective practices and receive feedback from stakeholders.
In addition to administering the pilot, the act directs the advisory group to work jointly with state medical and nursing schools to develop new curricula to prepare future primary care providers for the PCMH model of care.
|Defining & Recognizing a Medical Home||
PCMH Education Pilot Project: Substitute House Bill 198 (128thGeneral Assembly) specifies that: “the patient-centered medical home model of care is an enhanced model of primary care in which care teams attend to the multifaceted needs of patients, providing whole person comprehensive and coordinated patient centered care.”
The state’s PCMH website expands on this, outlining core features of a patient-centered medical home:
PCMH Education Pilot Project: TransforMED evaluated pilot applicants for their potential to become patient-centered medical homes. Also, while there are no current recognition requirements to participate, the patient-centered medical home education advisory group referenced the 2011 NCQA medical home standards in their final work product report.
ACA Section 2703 State Plan Amendment – Community Behavioral Health Centers (CBHCs): Participating CBHCs are required to achieve The Joint Commission’s Behavioral Health Care Accreditation Program Standards for Primary Physical Health Care or NCQA Level 1 PCMH recognition. In additon, providers are required to provide all core health home services; to integrate physical and behavioral health care; to have agreements with primary care providers if not co-located; to establish partnerships with managed care plans to support coordination between health homes and plans; and to have a variety of data collection and reporting capabilities.
CMS’s Comprehensive Primary Care Initiative (CPCi): Practices were selected for participation in CPCi through a competitive application process. Under CMS’s Comprehensive Primary Care Initiative, practices are not required to attain formal PCMH recognition; however, formal PCMH recognition through NCQA, AAHCC, the Joint Commission, URAC, or a state-based recognition program was viewed favorably in practice selection. Additional criteria included:
|Aligning Reimbursement & Purchasing||
PCMH Education Pilot Project: Substitute House Bill 198 (128thGeneral Assembly) requires the patient-centered medical home education advisory group to reimburse up to 75 percent of a practice’s health information technology investments for participating primary care practices (including training and technical support). Ohio is using meaningful use incentives in the HITECH Act to meet this requirement.
ACA Section 2703 State Plan Amendment – Community Behavioral Health Centers (CBHCs): Participating practices will receive a monthly case rate. Rates will varey by health home based on caseload and dedicated health home staffing costs for each qualifying enrollee.
CMS’s Comprehensive Primary Care Initiative (CPCi): This four-year multi-payer initiative, launched in October 2012, includes ten payers in the Cincinatti-Dayton market: Medicare, Ohio Medicaid, Aetna, Amerigroup, Anthem Blue Cross Blue Shield Ohio, CareSource, Centene Corporation, Humana, HealthSpan, Medical Mutual, and UnitedHealthcare.
Medicare pays selected practices a per-beneficiary per-month (PBPM) risk-adjusted care management fee which ranges from $8 to $40. CMS has indicated that it expects care management fees to average $20 PBPM during the first two years of the initiative. In Years 3 and 4, care management fees will average $15 PBPM. Medicare will also introduce a shared savings component beginning in Year 2, calculated at the market level.
The CPCi solicitation for payers indicates that participating payers (non-Medicare) are expected to follow a similar framework, paying per-member per-month (PMPM) care management fees to participating practices on top of fee-for-service and incorporating a shared savings component. Payment amounts will be negotiated individually with participating practices to comply with anti-trust laws.
PCMH Education Pilot Project: Substitute House Bill 198 (128th General Assembly) requires participating practices to receive comprehensive training on medical home operations, including leadership training, scheduling changes, staff support and care management.
ACA Section 2703 State Plan Amendment – Community Behavioral Health Centers (CBHCs): The Ohio Department of Mental Health and Ohio Office of Medical Assistance launched a Health Home Learning Community in February 2013. The state reports that it plans to “include a series of accelerated and intensive in-person and virtual learning sessions on a variety of topics including integration of physical and behavioral health needs, transitions in care, and assertive outreach and engagement with input from community mental health centers and key partners. The series will focus on high-quality care, improving care coordination and enhancing the consumer experience.” For more information on technical assistance for health home practices, visit the Ohio Medicaid Health Homes webpage.
PCMH Education Pilot Project: The patient-centered medical home (PCMH) education advisory group selected a number of practice and curriculum metrics. The selected metrics fall into six categories:
For specific measures selected, please see pages 7-8 of the advisory group’s final work product report.
ACA Section 2703 State Plan Amendment – Community Behavioral Health Centers (CBHCs): Ohio will use claims data to evaluate progress toward the state’s eight goals for the health home program: