Ohio Health and Human Services Innovation Plan

1.
Introduction
a.
Ohio’s is currently transforming its Medicaid delivery through the Ohio
Health and Human Services Innovation Plan. Initiatives have been gradually
enacted as Ohio
reforms its Medicaid system. Recently, Ohio has been
approved to receive up to $3,000,000 from the federal government to
develop the State Health Care Innovation plan (Governor’s Office of Health
Transformation, 2013).
b.
Thisanalysis of the Ohio Medicaid system seeks to explore access to health
care, health care financing, rationing of health care, quality of health care, and
the effectiveness of the programs as Ohio undergoes this healthcare
transformation.
2.
Access to
Health
Care
(Health Policy Institute o
f Ohio, 2013)
a.
Health coverage
/ insurance status
in Ohio
b.
Medicaid programs in Ohio
i.
Healthy start
–
children younger
than
19 and/or pregnant women
ii.
Healthy families
–
parents and children included
iii.
Aged, blind, or disabled (ABD)
–
adults 65+ or legally blind/d
isabled
c.
Eligibility, application, and renewal in Ohio
3.
Health Care Financing
a.
Total Medicaid spending in Ohio was $15,709,320,002 in the 2011 financial
year, the 6
th
highest state (Kaiser Family Foundation, 2013)
b.
Ohio Spends below the US average on acute ca
re, above the US average on
long term care, and matches the US average on disproportionate share
hospital payments
(Kaiser Family Foundation, 2013)
i.
Where money is coming from
ii.
Where money is being spent
c.
Cost containment actions
(Kaiser Family Foundation, 20
13)
i.
Ohio has enacted changes in provider payment rates, pharmacy
controls, long term care
ii.
Ohio has not enacted
changes in benefit
s
(
reductions
)
, eligibility
(
cuts
)
,
copays,
application/renewal
4.
Rationing of Health Care
a.
Federally mandated services vs
Ohio provided
(
optional
)
services
(Health
Policy Institute of Ohio, 2013)
b.
Delivery systems
i.
Managed Care
ii.
Fee
–
for
–
Service
5.
Quality of
Health
Care
a.
Health care quality measures assessment
(Sebelius, 2013)
i.
Ohio reports 10 out of 22 health care quality measures
ii.
National average is 14 out of 22 health care quality measures
b.
Ohio Ranks 35
th
in overall health care in 2012 (United Health Foundation,
2013)
6.
Effectiveness of Programs
a.
Service Use Indicators
b.
Current Department of Health Transformation Initiatives (Governor
’s Office
of Health Transformation, 2013)
i.
Modernize Medicaid
1.
Extend coverage to more low
–
income Ohioans
2.
Integrate Medicare and Medicaid
3.
Improve managed care plan performance
ii.
Streamline health and human services
1.
New claims payment system
2.
Simplify
eligibility
3.
Organize programs for children
iii.
Improve health system performance
1.
Coordinate health information technology
2.
Federal health insurance exchange
3.
Regional payment reforms
7.
Conclusion
.
.