In early 2019, Ohio Governor Mike DeWine called on the Ohio Department of Medicaid (ODM) to ensure Ohioans get the best value in providing quality care. In response, we embarked on a Medicaid Managed Care Procurement, with a mission to "focus on the individual rather than the business of managed care." In service of this mission, we first focused on hearing from individuals and providers. Through the Request for Information (RFI) #1 we gathered suggestions for improving the current Medicaid managed care program from nearly 1,000 individuals, providers, and advocates across Ohio.
This feedback informed development of RFI #2, outlining our vision for a reimagined statewide managed care program. The RFI seeks input from providers, associations, advocacy groups, data and information technology vendors, and managed care organizations.
RFI #2 is a continuation of the process initiated by Governor DeWine to implement some of the most innovative health care reforms in the country. It examines the current health care experience of nearly 3 million Ohio Medicaid consumers and offers ideas to reduce barriers, streamline access, and enhance health care delivery. With the reimagining of the Medicaid system in Ohio, ODM hopes to improve the design, delivery, and timeliness of care coordination. ODM requests input to achieve the following goals:
Improve wellness and health outcomes. To improve health outcomes and support individual wellness, ODM invites input on ways to formalize coordinated care partnerships between community-based organizations and managed care organizations that will reduce infant mortality and preterm births, increase healthy behaviors, promote tobacco cessation, and address health care inequities.
Emphasize a personalized care experience. The RFI invites ideas that strengthen the managed care organization and provider capabilities to deliver more personalized care. It seeks feedback on improving member-provider communications, technologies to increase consumer engagement and programs to enhance wellness behaviors and outcomes for individuals and their families as they access a continuum of care tailored to their unique needs.
Support providers in better patient care. In order to better support providers, ODM requests ideas and best practices to reduce administrative burdens such as centralized credentialing, standardized authorizations, and simplified medication management.
Improve care for children and adults with complex needs. To strengthen care for children and adults with complex medical and behavioral health needs, ODM plans to develop a formalized model of care coordination, to tailor behavioral health services to meet the unique needs of children served by multiple state systems and children with other complex behavioral health needs, and to create robust partnerships between community-based organizations and managed care organizations.
Increase program transparency and accountability. Program transparency through the use and analysis of real-time, reliable data can dramatically strengthen care oversight and outcomes. ODM seeks input to enhance data analytics and consumer health care dashboards, such as its newly introduced unified prescription drug list, to streamline support and drive accountability across the continuum of care.
RFI #2 will close on Tuesday, March 3, 2020 at 4:00 p.m. EST. Responses will be reviewed and considered as ODM continues to develop and finalize the design for the future program structure and the Medicaid Managed Care Procurement Request for Application (RFA).