Ohio has made progress in closing the coverage gap—a key component of making healthcare affordable for residents. Of possible concern, some Medicaid beneficiaries have to work, attend school, volunteer or attend job training to maintain coverage starting in 2021—potentially reducing rates of coverage.
In recent years, Ohio's Office of Health Transformation has worked to provide better-integrated and coordinated care to residents, including an integrated eligibility system that helps Medicaid enrollees determine whether they qualify for food assistance, child care and cash assistance and a program that matches the state's neediest mental health patients with providers best suited to their needs. Moreover, Ohio has been proactive about regulating pharmacy benefit managers (PBMs) after a study commissioned by the Ohio Department of Medicaid found that PBMs were engaging in "spread pricing"—a practice where PBMs pocket the difference between what they bill to the payer for medications and what they pay the pharmacy to dispense drugs.
Like most states, Ohio needs to do more to address high healthcare prices and tackle the spending associated with unnecessary and low-value healthcare, tasks made more difficult due to the absence of an all-payer claims database. Moreover, Ohio performs poorly on several population health and other outcome measures, according to the Health Policy Institute of Ohio.
Ohio ranked 20 out of 47 states plus DC, with a score of 36.1 out of 80 possible points in the Hub's 2021 Healthcare Affordability State Policy Scorecard.
Columbus city leaders announced $335 million in medical debt forgiveness for residents, reports
The Columbus Dispatch. The City Council partnered with the Central Ohio Hospital Council to
provide debt relief for Columbus residents who were treated at any and all of the four area
hospital systems that make up the council from 2015 through 2020. Patients earning between
200 and 400 percent of the federal poverty level are eligible for relief. The council estimates
340,660 Columbus residents will receive debt forgiveness, with an average of $984 in debt
relieved per patient.
Ohio Governor DeWine announced a community-based program aimed at improving the health and well-being of moms, infants, and families, reports Cleveland.com. Obstetrical practices participating in the program are required to measure and engage with patients related to access to care, cultural competency, and communication methods. Practices are expected to formally assess practice strengths and patient needs to ensure resources and best practices available are used to achieve healthier outcomes. Practices that participate in the program will be reimbursed by the state’s Medicaid program in a payment structure that rewards providers who address family needs through prenatal, birth, and postnatal periods. Ohio Medicaid estimates the program will cost five million dollars by the end of this first year, reaching over 14,000 pregnant and postpartum patients and enrolling 77 medical practices.
The city of Toledo and Lucas County, Ohio, used $1.6 million in federal funds to forgive $200 million in medical debt for their residents, reports The Blade. The Toledo City Council and Lucas County Board of Commissioners partnered with RIP Medical Debt, a charity that buys and forgives medical debt across the country, to provide relief in the community where over 41,000 residents have medical debt. RIP Medical Debt has traditionally relied upon private donations; this is the first such time that city and county resources have been devoted to relieving medical debt through the nonprofit—providing a model for other communities.
The Ohio Department of Health is awarding 15 contracts for 136 new or expanded school-based health centers throughout the state, according to the Office of the Governor. The clinics will provide primary care and preventative care, including vision, dental and behavioral health in school settings. These clinics will eliminate many barriers to obtaining care, such as transportation, child time out of the classroom, parents missing time at work and a lack of provider or medical home. These clinics have emerged as effective models to improve student access to healthcare and have helped close the gap for children in underserved communities.
The Health Policy Institute of Ohio released a fact sheet on the connections between racism and health, aimed at engaging policymakers to take action to advance health equity. The fact sheet highlights three key findings for policymakers: racism is a health crisis; racism manifests itself across all levels of society; and many opportunities exist to dismantle racism. In addition, it details the health impacts of racism and health disparities across Ohio. Finally, the fact sheet details ways for policymakers and others to take action to dismantle racism and achieve health equity for all Ohioans.
Ohio ranks 47th in the nation in health value as compared to other states and D.C., according the Health Value Dashboard from the Health Policy Institute of Ohio. The Dashboard found that the majority of Ohio’s healthcare spending is on downstream factors of health to treat health problems, particularly due to a lack of investment in children, equity and prevention. The equity profiles highlight many health disparities experienced by Ohioans, including that Black, Hispanic and Ohioans with disabilities are more likely to be unable to see a doctor due to cost than white Ohioans or Ohioans without disabilities. The Dashboard recommends nine policies to improve health value in Ohio, including: strengthening the public health workforce; training on racism and discrimination; and increasing eligibility for a childcare subsidy.
Ohio has passed a new law to protect residents from surprise medical bills, according to The Center Square. The bill creates a baseball-style arbitration process between the provider and the insurance company—one that does not place patients in the middle. The legislation seeks to stop the practice of patients being charged for out-of-network services at the out-of-network rate when they are performed at an in-network facility.
The Ohio Department of Medicaid seeks to update its managed care setup with a focus on population health, meeting the needs of children with complex needs and reducing administrative hurdles for patients and healthcare providers, according to Health Policy Institute of Ohio. The state has invited privately operated managed care organizations to submit applications. These changes are the result of comments provided by beneficiaries, physicians, hospitals and other healthcare providers. Many highlighted concerns with the current system that forced families with children in need of intensive and costly services to relinquish custody for their children to be eligible for Medicaid. Under the plan, Ohio Rise, some youth would qualify for modified eligibility requirements, allowing them to receive assistance while remaining in their family’s custody
Black Ohioans make up about 13 percent of the state’s population but accounted for larger percentages of COVID-19 cases (22.8%), hospitalizations (30.6%) and deaths (18.7%), while white Ohioans make up about 82 percent of the state’s population, but accounted for smaller percentages of COVID-19 cases (53.1%), hospitalizations (56.9%) and deaths (77.5%), according to a new report from Health Policy Institute of Ohio.
A new report from the Center for Community Solutions found prices for the same medical procedures varied widely among hospitals in Ohio, reports AboutHealthTransparency.org. The research found that not only did the price vary widely from hospital to hospital, but also, for each procedure the average cost in Ohio was much higher than the national average. The authors highlighted recommendations for controlling prices in Ohio, including one to create an independent oversight entity to set a cost benchmark.
Ohio’s “minority health strike force” has issued a report containing 34 recommendations aimed at dismantling racism, removing public health obstacles, improving the social, economic and physical environments and strengthening data collection to better track disparities. These efforts are part of the state’s developing blueprint to reduce health inequities, the Columbus Dispatch reports. African Americans make up around 14 percent of Ohio’s population but comprise close to 19 percent of the state’s COVID-19 deaths, according to data from the Ohio Department of Health.
The Ohio Department of Health has released a 2020-2022 State Health Improvement Plan, according to the Health Policy Institute of Ohio. Agency strategies focus on four broad categories: community conditions; health behaviors; access to care; and mental health and addiction. For example, strategies aimed at improving local access to healthcare providers focus on creating comprehensive and coordinated primary care, a culturally competent workforce in underserved communities and telehealth.
In response to healthcare outcome disparities surfaced by the COVID pandemic, Ohio legislators have launched a plan to address the gap, according to Rewind Columbus. These new strategies include: expanded access to testing through a partnership with the Ohio Association of Community Health Centers; a new position within the Department of Health dedicated to studying social determinants of health; an increase in the number of public health workers assigned to notifying residents of possible exposure to the virus; and interactive maps on the department's coronavirus web page displaying data on social determinants of health and their impact in the state's 88 counties. Currently, African Americans make up 14 percent of Ohio’s population, but represent 26 percent of the confirmed COVID-19 cases, 31 percent of hospitalizations from the disease and 17 percent of the deaths.
The Ohio Hospital Association estimates a $1.2 billion negative financial impact to Ohio hospitals every month, according to Modern Healthcare. In addition to the cost implications of shifting away from nonessential surgeries and procedures, hospitals are grappling with increasing prices in the supply chain for the equipment they desperately need to treat COVID-19 patients. The state has already launched the Variable Rate Demand Obligation (VRDO) Stabilization Program, which aims to provide added liquidity and ease the financial pressure hospitals face as they respond to the pandemic.
Ohio’s Prescription Drug Transparency and Affordability Advisory Council, a panel of government, business and consumer advocates exploring ways to ensure that pharmaceutical drugs, has convened to discuss their recommendations for the state’s governor, according to the Times Reporter. Ohio currently spends about $3.5 billion a year on prescription drugs for state employees, injured workers, Medicaid beneficiaries, incarcerated prisoners and others. The Advisory Council is considering bulk purchasing and price transparency strategies..
Premiums and deductibles in 2018 were 10 percent or more of the median income for workers in 42 states, including Ohio, according to a Commonwealth Fund report. In Ohio, the average premium contribution and deductible made up 11.1 percent of median household income, compared with 6.9 percent in 2008. Rising deductibles could make employees more likely to delay or skip care or, to not take prescription medications, an analysis from the Health Policy Institute of Ohio stated.
Half of Ohio residents surveyed experienced healthcare affordability burdens in the prior year: they either went uninsured, struggled to pay for medical care, or avoided or delayed it, according to new Altarum Healthcare Value Hub survey data released by the Universal Health Care Action Network of Ohio. A quarter of respondents said they did not fill prescriptions, cut their medications in half or skipped doses due to cost, Statehouse News Bureau reports. Additionally, about a third of privately insured Ohioans said they'd gotten a bill they didn't anticipate, and only a third of those were solved satisfactorily.
A looming physician shortage in Ohio could make it difficult for patients to see a primary care physician, increase health disparities and raise costs as people are forced to turn to emergency room care, according to The Plain Dealer. By 2025, Ohio is projected to be short 1,200 primary care physicians (those in family medicine, internal medicine or pediatrics), estimates the U.S. Department of Health and Human Services. Recruiting primary physicians can be challenging due to pay inequities (primary care physicians make 30 percent less than specialists) and increased workload. Medical schools such as Case Western Reserve University School of Medicine are changing their recruitment and curriculum strategies to encourage more students to choose primary care.
After an audit revealed that a 8.8 percent spread between what pharmacy benefit managers (PBMs) charged Medicaid managed care plans and what they paid to pharmacies, Ohio Medicaid directed managed care plans to end their contracts with pharmacy benefit managers, effective January 2019. Plans were instead asked to adopt a transparent “pass-through” pricing model whereby the managed care plan would pay the PBM the exact amount paid to the pharmacy for the prescription drug, a dispensing fee, and, in lieu of spread-based revenue, an administrative fee, according to JAMA. Ohio policymakers also pursued the prohibition of gag clause by PBMs, which prevent pharmacies from sharing with patients the most cost-effective option when purchasing medications. Uniquely among states, Ohio’s approach includes assessing the potential effect of these reforms on outcomes and evaluating gains after reform implementation.
In Ohio, the Office of Health Transformation, created in 2011, convenes all agencies that touch healthcare, including Health, Medicaid, Mental Health and Addiction Services, Jobs and Family Services, Veterans Affairs, Administrative Services, as well as representatives of the private insurance market -- to dedicate some time to reforms and long-term health improvement and to agree on which population health goals are most urgent, according to Governing. The Office helped develop an integrated eligibility system so Medicaid beneficiaries could see whether they also qualified for food assistance, child care, child welfare and cash assistance after the state expanded its Medicaid program. Additionally, to prevent providers from declining to see the patients with the biggest mental health needs, and to help those patients avoid having to hunt down doctors who would see them, the state identified the 5 percent of patients that were the costliest in behavioral health and matched them with a provider who could best serve them. As a result of these efforts and Medicaid expansion, Ohio has made large strides in transforming healthcare delivery in the state.
Ohio is fighting to release a report detailing what it paid to two PBMs, CVS Health and Optum, to manage its Medicaid program’s prescription drug plans. According to NPR, the report shows that the companies charged the state 8.8 percent more than they paid to pharmacies to fill prescriptions. The companies kept the more than $224 million difference between what they charged the state and paid for the drugs. Ohio's Medicaid program is run almost completely through private managed care insurance companies, who contract with CVS Health and Optum to manage the prescription drug portion of recipients’ coverage. CVS Health representatives have argued that the company saved the state $145 million compared to an alternative and releasing the report would harm the company’s ability to negotiate low prices.
Ohio Attorney General Mike DeWine is ramping up his investigation into the costly practices of pharmacy middlemen, hiring outside counsel to assist with a probe he expects to lead to litigation against companies managing drug benefits for Medicaid and other tax-funded health insurance programs. According to The Columbus Dispatch, DeWine stated that “today, I am putting PBMs [pharmacy benefit managers] on notice that their conduct is being heavily scrutinized, and any action that can be taken and proven in court will be filed to protect Ohio taxpayers and the millions of Ohioans who rely on the pharmacy benefits provided.” The announcement was applauded by the Ohio Pharmacists Association but criticized by political opponents who characterized the move as an empty gesture designed to shore up votes before the election.
New data from Ohio's Quantum Health reveals that its Precision Specialty Pharmacy Management program reduced cost by 55 percent, or an average of over $80,000 per case annually, for members transitioning from insurance carriers to the company's consumer healthcare navigation model. According to Markets Insider, Chief Medical Officer Dr. Dana Andrews attributes the results to the company's active collaboration with the members and their providers to identify those who could receive the medication in a more cost-effective site of care. Currently in the U.S., the 1 to 2 percent of people who take specialty medications drive nearly 40 percent of all drug spending.
Franklin County Public Health’s launched a new Community Cessation Initiative that offers free counseling to help residents kick the tobacco habit, according to a news article in The Columbus Dispatch. The three-year Community Cessation Initiative, referred to as CCI, will place special emphasis on people who are pregnant, have low socioeconomic status or have mental-health and substance-abuse disorders. But any resident can participate, and advocates hope to reach about 26,250 people, or 15 percent, of the roughly 175,000 tobacco-users in the county. The partners will provide CCI with contact information for people who want to quit. Each will be given a phone call within 72 hours, asked a few questions and referred to a provider. Once that referral is made, the provider will contact the tobacco user to begin treatment. Participants will be followed after treatment to offer support and help with any relapses.
OhioHealth patients soon will be able to access their medical records and test results on their iPhones with the upcoming release of Apple’s mobile operating system, according to an article in the Columbus Business First. The 10-hospital Columbus system was among a dozen nationwide that Apple chose for a beta test of the feature, along with Johns Hopkins Medicine in Baltimore, Cedars-Sinai in Los Angeles and Rush University Medical Center in Chicago. Apple selected systems representing a range in sizes that already had made significant technology upgrades to be able to integrate their records with the app. OhioHealth spent more than $200 million in a multi-year project completed in 2016 to replace several legacy vendors with a single electronic medical record from Epic Systems Corp. at all its hospitals, clinics and physician offices.
Central Ohioans could soon see at least two new small hospitals as part of a nationwide trend. These so-called “microhospitals” typically have eight to 10 inpatient beds and such core services as emergency care, outpatient services, labs, imaging and pharmacies, according to a news article in The Columbus Dispatch. They target communities that might not need a full-blown facility. It’s a way to introduce a higher level of care to a community in a manner that is appropriate for the community size and health-care needs. These facilities can be more cost-efficient than full-service hospitals for handling lower-acute needs.
The northeast region of Ohio, centered around the city of Akron, has improved on more performance measures (19 of 33) than any other region, according to the Commonwealth Fund’sScorecard on Local Health System Performance, 2016 Edition. The region has made notable progress expanding access to care. Health systems also have strengthened primary care and improved care transitions, which may explain reductions in potentially avoidable hospitalizations and unplanned readmissions. Collaboration across health and social service sectors is a hallmark of the region, exemplified by use of a shared set of measures assessing residents’ quality of life.
The U.S. Department of Health and Human Services has awarded nearly $3.6 million to 45 health centers in Ohio to improve their operations, according to an article from Cleveland Business. Ohio health centers are receiving a total of $3,582,514 to continue improving their services based upon high levels of performance in one or more of the following categories: improving quality of care, increasing access to care, enhancing delivery of high value health care, addressing health disparities and achieving Patient-Centered Medical Home (PCMH) recognition.
A battle over high drug prices has become a battle over transparency—specifically, which drug makers are funding an effort to block a measure on the Ohio ballot this November that seeks to rein in the state’s drug prices. According to Stat News, the proposal in Ohio is similar to the one that California voters shot down last November following a huge oppositional push from drug companies; it’s even backed by the same group, the AIDS Healthcare Foundation, which runs a nonprofit network of clinics.
Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients an estimate of what non-emergency services would cost individuals after insurance before they commenced treatment, according to a report by Kaiser Health News. Many patient advocates say such transparency would be helpful for patients, allowing them to shop around for some services to hold down out-of-pocket costs, as well as adjust their household budgets for upcoming health-related outlays in a time of high-deductible plans.
There’s an uneasy relationship between the Cleveland Clinic—the second-biggest employer in Ohio and one of the greatest hospitals in the world—and the community around it. According to Politico, the Clinic’s status as a nonprofit ensures it doesn’t have to pay tens of millions of dollars in taxes, but it is supposed to fulfill a loosely defined commitment to reinvest in its community. However, the surrounding community is poor, unhealthy and—in the words of one national neighborhood-ranking website—“barely livable.”
A recent poll found that twenty percent of adult Ohioans reported they or a family member put off medical care due to cost in the previous year, according to Columbus Business First. Affordability varied by income and education level, with individuals without a college degree and earning just above the eligibility level for Medicaid struggling the most to pay for needed care.
On May 10, 2016, the Ohio Department of Insurance approved the merger of Aetna and Humana with little public notice, according to a press release by the Universal Health Care Action Network. No hearings were held on the matter, despite requests from consumer advocates. The merger would result in the combined entity controlling approximately half of the Medicare Advantage market in Ohio.
State lawmakers are pushing for a law that would require medical providers to provide patients with a “good-faith and reasonable” estimate of a procedure’s cost, including how much insurance would cover and what the patient’s share would be, according to the Columbus Dispatch. The bill, which has bipartisan support, would require the changes as early as January of next year and represents the state’s most significant effort on price transparency in years.
Under the administration of Governor John Kasich, Ohio has taken steps to move the state towards value-based purchasing and other key health policies, according to a case study conducted by the Urban Institute that examined state stewardship of healthcare. State stewardship is defined as the active pursuit of system-wide improvements in health that go beyond traditional public health and purchasing efforts. The Urban Institute also profiled Colorado, Minnesota, Oregon, and Vermont in order to provide a broad overview of how states are approaching healthcare stewardship.
Cleveland Plain Dealer: Independence at Home, a Medicare pilot program that considered the cost saving possibilities of delivering primary care at home, was tested at the Cleveland Clinic. According to data released from the Centers for Medicare and Medicaid Services (CMS), the program saved about $25 million in healthcare spending for the 8,400 patients enrolled during its first year. The Cleveland Clinic plans to expand the in-home care model.
Cleveland Plain Dealer: Cuyahoga county department of public health released an initiative called HIP-C, or Health Improvement Partnership-Cuyahoga. HIP-C's most difficult goal, though, will be in changing the prevailing attitude, which holds that individual behavior change is enough to turn around the health of a community.
The Universal Healthcare Action Network Ohio released a survey report titled Community Health Workers: At the Heart of Transforming Ohio’s Healthcare Delivery System. The survey, conducted in 2013-14, explored how community health workers were being utilized throughout Ohio. The results show that community health workers are effective in their work because of their knowledge of the communities in which they work.
The Health Policy Institute of Ohio created a Health Policy Value Dashboard that lays out the different value incentives in Ohio healthcare.