Ohio Adding Incentives For Medicaid Providers

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Ohio wants to increase Medicaid payments to doctors with good track records.(Photo: Flickr)
Ohio wants to increase Medicaid payments to doctors with good track records.(Photo: Flickr)

The state is changing the way it will pay Medicaid providers in Ohio.

And the Kasich administration’s move is getting positive feedback from advocates for the 2,000,000 Ohioans on Medicaid.

Ohio is the first state to join the non-profit Catalyst for Payment Reform, an organization that’s working with major for-profit employers such as Wal-Mart and General Electric. The organization will help the state as it prepares to rebid its contracts with Medicaid providers.

Greg Moody with the Governor’s Office of Health Transformation says simply put, the state will pay more to Medicaid providers who have a track record of keeping patients healthy, and less to those whose patients get and stay sick.

“We are not trying to predict exactly what this might save. We’re doing this because we want to see quality and performance improve, and I’m confident that if we’re able to do that then there will also be savings down the road for Ohio taxpayers,” Moody says.

The state spent $14 billion on Medicaid coverage last year.

So far, Moody says, he hasn’t heard any negative response from Medicaid providers. Also supportive: groups that represent consumers in the Medicaid program, including Cathy Levine with the Universal Health Care Network of Ohio.

“The problem with our system now is that doctors are not paid to spend time with patients or to coordinate care among providers, but that doctors are paid for producing volume of care. And payment reform is at the heart of creating patient-centered, safer, better care for patients,” Levine says.

Levine says the current payment system allows health care costs to soar out of control because patients are shuffled among providers who don’t talk to each other or to the patients, resulting in unneeded procedures and tests. But Levine says the details of how the system works are important to watch.

“We have to make sure that doctors are not being paid to give less care, but rather that they’re being paid to give the best care. Therefore, the incentives to providers have to be transparent to consumers.”

Levine says patients need to have input, and Moody says that there should be a financial incentive for patients to seek primary and preventative care, which cost less. A

And Moody says he’s hoping the idea of payment reform will spread beyond the state’s reach.

“Whoever’s dollar is purchasing insurance – in this case, the Ohio Medicaid program, in another case, maybe your employer – that we expect more from our health insurance companies to not just pay the bills, but to say, ‘we’re going to do our homework to see which providers get the best outcomes, and we’re going to encourage you to see those providers,’” Moody says.

The state also wants to link providers who deal with the 190,000 Ohioans on both Medicaid and Medicare, so they would have to deal with only one agency to receive services.

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