For close to a decade, Ohio has been a quiet but determined leader in the value-based care community. Building off a State Innovation Model (SIM) grant in 2013, the Buckeye State has completely overhauled its Medicaid program by implementing a multifaceted, value-driven program designed to improve quality and reduce unnecessary costs.
The two arms of the reform project, the Comprehensive Primary Care (CPC) program and Episodes of Care (Episodes) initiative, encourage primary care providers, specialists, and hospitals to coordinate care, proactively manage chronic conditions, and trim avoidable utilization in exchange for certain financial incentives.
(We dive deeply into these two programs in our downloadable guide for FQHCs in Ohio.)
The six-year SIM grant ran its course in 2019, but Ohio is far from finished with its value-based care transformation.
As the state doubles down on its investment in CPC and continues to roll out new value-based care options, federally qualified health centers (FQHCs) have an exciting opportunity to secure their share of financial incentives for improving quality and reducing spending for Medicaid beneficiaries.
Gauging the success of value-based care in Ohio
Ohio has learned some valuable lessons from its decade-long experience with value-based care – and it has seen some impressive results thus far.
Successes in the Comprehensive Primary Care (CPC) Program
As of 2019, CPC covered approximately 40 percent of the total state Medicaid population. From 2015 to 2017, overall quality performance of CPC practices improved by approximately 2.2 percent annually while producing $78.1 million in net annual savings. In just the first year of the problem, Medicaid issued $31.2 million in PMPM payments to CPC practices.
Successes in the Episodes of Care (Episodes) Initiative
Participants in the Episodes track achieved a 0.9 percent decrease in the average non-risk-adjusted spend trend from 2015 to 2017, resulting in an estimated $31.8 to $92.2 million in annual savings. The three episodes linked to payment from 2016 onward saw an even greater spend trend decrease, producing an annualized decrease of 2.4% from 2015 to 2017.
While the Episodes program is on hold, CPC keeps growing in popularity. In 2022, the program gained 23 new practices and 6 new partnerships, adding to the 281 practices that re-enrolled after the 2021 performance period.
The results are highly promising for the future of Ohio’s value-based care initiatives. The continued growth of CPC, along with positive financial trends, makes the program an attractive opportunity for FQHCs that wish to enhance their revenue opportunities while providing coordinated, team-based care to vulnerable communities.
Download our guide to better understand how FQHCs can capitalize on the opportunities of value-based care in Ohio.