Record Detail

PROGRAM SPONSORSHIP Formal name of the incentive and/or reward program initiative (if applicable) Program name Ohio Medicaid Managed Care P4P Program Program sponsor(s) and parent organization of sponsor(s), if applicable Program sponsor(s) Ohio Medicaid Managed Care, The Ohio Department of Job & Family Services Primary program contact information Name Mina Chang, Ph.D. Title Chief, Performance Review and Business Support Section Organization Bureau of Managed Health Care, Ohio Department of Job and Family Services Email changy01@odjfs.state.oh.us Phone (614) 466-4693 Sponsoring organization type Government(s) State Specify Ohio - Medicaid Managed Care Source of funding associated with program set-up costs Funding source Funded by program sponsor(s) Percent contributed by sponsor and grant organization Program set-up costs 0 Source of funding associated with program operations costs Funding source Funded by program sponsor(s) Percent contributed by sponsor and by grant organization Program operations cost 0 Start date & end date of the program Start Date 1/1/2002 End ongoing   PROGRAM SCOPE Geographic scope of program Ohio Individuals affected by program as a percentage of total population, if known Medicaid (indicate %) 66 Coverage of affected individuals (for purchaser sponsors only) HMO Direct target(s) of your program's incentives/rewards Health plans (for employers that reward plans only) HMO Medicaid Recruitment of program targets Mandatory- all members of the target group must participate (e.g. part of contracting) Mandatory- all members of target group that meet certain criteria Specify 1. Serving the Covered Families and Children (CFC) Program for 3 years, or the Aged, Blind, or Disabled (ABD) Program for 2 years. 2. Meet standards for a set of qualifying measures. PROGRAM PERFORMANCE MEASURES Clinical/Safety Performance Inpatient clinical and safety measures included in your program Measure sources Other Specify HEDIS like measures Measure areas Pulmonary Chronic obstructive pulmonary disease (COPD) Other measurement areas Hypertension: Inpatient Hospital Discharge Rate Outpatient clinical and safety measures included in the program Measure sources HEDIS (clinical components) Measurement areas Cardiac Coronary artery disease (CAD) Other Specify Congestive Heart Failure Pulmonary Adult Asthma Pediatric Asthma Other measurement areas Diabetes Mental health/substance abuse Prenatal care Adult Preventive Care Pediatric Preventive Care Other Specify Case Management Rate of Members Health plan performance measures Health plan measures HEDIS scores CAHPS scores Other Performance measure weighting Clinical performance % or N/A 80 Patient-centeredness (i.e. HCAHPS) % or N/A 7 Other Specify 13 Data Reliability Sources of data Existing or new data Existing data sources Data type Administrative in origin (derived from claims data) Other Specify CAHPS survey data; provider panel data Data extracting entity Other Data aggregator/analyzer Program sponsor Ensures data accuracy Yes Means of ensuring accuracy Other Specify 17 Data Quality Performance Measures INCENTIVE/REWARD CHARACTERISTICS Start date & end date of the incentive/reward Start Date Annual using State Fiscal Year End Date ongoing Structure of the incentive or reward Direct financial reward- increased payment PMPM or other payment increase for health plans Specify 1% PMPM Other Specify Additional monetary rewards Direct financial penalty Withhold/performance guarantee tied to performance goals Scoring used to determine payment Absolute goals- population level measures Pay for meeting one overall measure/group of measures Pay for meeting specific sub goals related to overall measure/group of measures Incremental goals - improvement over previous reporting period Other Specify A set of qualifying measures for P4P program Frequency of reward or penalty Annually Time lag between measurement and receiving reward/penalty Three - six months Source of financial payments for meeting performance goals Other Specify 1% of PMPM; Incentive fund account set aside COLLABORATION CHARACTERISTICS Phases of program where sought target collaboration Program design and creation Program operations Characteristics of pre-implementation target feedback Other Specify Health Plans input in program Receives compensation for administrative burden of data collection Yes Characteristics of post-implementation target feedback Incentive target given opportunity for full explanation of results before use Incentive target groups/individuals given comparative information Information provided on how results will be used Mechanism to consider additional information and communicate back to target Process available for target to provide additional information and/or corrections Blinding of performance feedback with targets Results disclosed with comparison to benchmarks Results to peers with names disclosed Frequency of performance feedback to the targets Quarterly Semi-annual Annually PROGRAM EVALUATION How the program evaluates its success Improvements in clinical performance Evaluator Program sponsor Additional results of program evaluation Improvements over time on some clinical measures, access and case management measures are notable. The P4P program has not been formally evaluated. However, results of all performance measures are shared with health plans and publicly disseminated after reports are finalized. Results are compared to national benchmarks and trended longitudinally when appropriate. Lessons learned from designing and implementing the program Stakeholders' buy in is important. A formal and independent evaluation of the effectiveness of the program can add credibility and help with further development.

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