Late last week, the Ohio Department of Medicaid (ODM) announced which managed care plans (MCPs) will implement the state’s new vision for providing care to its three million plus Medicaid recipients.  Three of its current providers (CareSource, Molina and United Health Care) and three new insurers (Humana Health Plan of Ohio, AmeriHealth Caritas of Ohio and Anthem Blue Cross and Blue Shield) have been selected.  This new arrangement is scheduled to begin at the start of CY 2022.  We will likely see a great deal of activity take place over the next nine months to implement the state’s new vision for Medicaid.


How will these changes impact behavioral healthcare (BH) providers in Ohio?  While we have a good idea about the general direction that ODM wishes to take based on the draft MCP agreement posted on their website, specific information will gradually become known as the process plays out during the upcoming nine months.  One of the prominent changes that we can expect involves the implementation of performance contracting.


In the “Briefing Document” that ODM sent out late last week, they emphasize the following: “Provide more flexibility in establishing alternative payment models with providers who focus on patient care and improve outcomes.”  While we lack specifics on what alternative payment models/performance contracting will look like, we can likely expect that the MCPs will begin to implement these arrangements in CY 2022.  Over time, this form of payment for BH providers will become predominant, supplanting fee for service reimbursements.


Performance contracting reimbursements will involve metrics largely based upon established HEDIS measures and other quantitative benchmarks that are appropriate for a behavioral healthcare practice.  An example of a metric that BH providers are likely to be measured by is their ability to reduce emergency department visits by clients.  Currently, behavioral healthcare does not have an extensive list of quantitative measures for evaluation purposes.  However, we will likely see this expand as performance contracting becomes a larger percentage of Medicaid reimbursement.

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