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.@Communitysols is submitting comments in response to @OhioMedicaid request for information as they begin the process of selecting new managed care partners; comments focus on 2 themes, social determinants and mandatory data sharing communitysolutions.com/public_testimo…
@CommunitySols @OhioMedicaid TY to my @CommunitySols colleague @lorenanthes for editing our comments, it was a huge task, and thanks to everyone who helped inform these comments
@CommunitySols @OhioMedicaid You can follow my thread for a few of the @Communitysols recommendations that jumped out at me; the state selection of new managed care plans provides a great opportunity to advance sound, cost-effective policies that maintain access and improve quality
@CommunitySols @OhioMedicaid Health care is estimated to account for only 20% of the contributors to healthy outcomes; Ohio’s #Medicaid managed care plans can play a more significant role as a conduit between Ohio’s human service and medical delivery systems to address the other 80%
@CommunitySols @OhioMedicaid Ohio should ensure that there is an equity framework in its efforts, contractually; there are tools the National Quality Forum has developed which provides guidance for states to address disparities and rural health.
@CommunitySols @OhioMedicaid Ohio’s report card on #Medicaid managed care needs to raise its standards and more fully their performance relative to peers, nationally, and also utilize more comprehensive available reports like the Ohio’s external quality review
@CommunitySols @OhioMedicaid To improve performance Ohio should also consider a “secret shopper” program for each of the plans wherein customer service integrity, regarding the key functions of the plan, is tested and evaluated across populations and geographies
@CommunitySols @OhioMedicaid Ohio should encourage MCOs to recalibrate rates away from acute care to primary care; MCOs could pay less for inpatient care and invest those dollars directly into primary care
@CommunitySols @OhioMedicaid To promote workforce development, @OhioMedicaid should collaborate w/ relevant state agencies to explore strategies for ‘forgiving’ student loans for those who choose to enter the ‘public’ social services professions, including waiving licensing fees and costs of continuing educ.
@CommunitySols @OhioMedicaid Ohio should consider a pay for performance program specific to social determinants; $ not awarded should be deposited into the department's recoveries fund and transfers could be made to other state accounts supporting the social determinant categories developed by the state.
@CommunitySols @OhioMedicaid Ohio could reward plans performing better relative to specific populations w/ less risk + greater enrolee market share; e.g. reward plans w/ a greater market share of parents & children if they outperform in meeting Early & Periodic Screening, Diagnostic & Treatment expectations
@CommunitySols @OhioMedicaid Children & youth w/ serious emotional disturbances and multi-system youth (MSY) require a higher level of care management; there should be specific protocols to assure that MSY +families are receiving coordinated care management
@CommunitySols @OhioMedicaid Persons living with #HIV should be a population that receives special attention from the state; a quality metric around viral suppression should be created w/ the achievement being a mandatory part of a shared case management process.
@CommunitySols @OhioMedicaid Q. the most important indicators of system/managed care plan performance? A. Accuracy of PCP Assignment, EPSDT completion rates, HEDIS performance relative to national peers, Elimination of disparities, Security (housing and food access, specifically)., and Smoking cessation
@CommunitySols @OhioMedicaid Ohio should develop non-HEDIS measures which increase housing stability as it is one of the primary social determinant of health; a local physician told me that their average NICU mom had moved 3-5 times during their 9 months of pregnancy.
@CommunitySols @OhioMedicaid There is lot more packed into these @CommunitySols recommendations, so again check them out at communitysolutions.com/public_testimo…
@CommunitySols @OhioMedicaid You can find the @OhioMedicaid managed care request for information here medicaid.ohio.gov/FOR-OHIOANS/Ma…
