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Enhancing Ohio's Sustainability Through Innovative Healthcare Solutions

Explore the vision for sustainable healthcare in Ohio's challenging landscape, focusing on increased demand and decreased resources. Discover strategies to navigate the $8B deficit and leverage patient-centered models for improved outcomes and cost management.

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Enhancing Ohio's Sustainability Through Innovative Healthcare Solutions

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  1. Ohio’s Vision for Sustainability ANCOR Fall Leadership Summit October 24, 2011

  2. Increased Pressure for Resources • Increased demand for services • 27,000 on waiting list • Direct support professional crisis • Wages • Benefits • Turnover • Decreased Resources • $8B deficit • Inflation

  3. Tools • No HCBS DD waiver provider rate cut • 1.5% reduction in per member per month (pmpm) • 3% voluntary reduction in service utilization • Managed care • Role in our system • Patient-Centered Medical Home - ACO • Waiver reimbursement pilot • Leverage

  4. Patient-Centered Medical Home - ACO • Patient-Centered Medical Home • Geography or diagnosis • IADD-specific • Current coordination • Partnerships • Possible role of IADD providers • Primary medical care and health home services • Health home services • Subject Matter Expert (SME) • Memorandum of Understanding (MOU) • Affordable care organization

  5. Waiver Reimbursement Pilot • 15 minute rate • Misaligned incentives • Realignment of incentives by state, county boards and providers • Same or improved outcomes – shift focus from inputs to outcomes • Better manage expense • Decrease administrative expense

  6. Possible Pilot Model • Weekly rate • Acuity based case rate • Utilization adjusted • Efficiency dividends for state, counties, people on waiting lists and providers • Service planning • Oversight role • Quality • Access • Cost

  7. Why a Pilot? • “If we knew it would work, we wouldn't need a pilot.” • Dynamic • Collaborative • Longer view

  8. Leverage • Shared service models • Acquisitions and mergers • Collaboratives • Member services • Strange bedfellows

  9. Thank You! Mark Davis Ohio Provider Resource Association 1152 Goodale Boulevard Columbus, Ohio 43212 614.224.6772 mdavis@opra.org

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