Ohio Health Quality Improvement Plan

Pa y m e n t Re f o r m◦◦◦◦◦◦Work with HIT group to develop the software/back office operations needed by small providers and providers inunderserved areas to integrate e-health records, e-billing and electronic eligibility verification efficiently;Develop training programs and a communications plan to support e-health records, e- billing and electronic eligibilityverification; andEstablish metrics to evaluate effectiveness and value of initiatives.Tactic 3: Develop payment policies and reform models that discourage the overuse, underuse and misuse of health care services,products and procedures when evaluated against standards and protocols of evidence based care.• Use available information and criteria to identify likely procedures, practices, pharmaceuticals and technology that providelittle or no value, or have the potential to cause harm.• Collect and analyze Ohio medical claims data from a broad and diverse data set to determine the incidence and prevalenceof such utilization overall and for at risk populations.• Establish metrics to improve patient safety.Tactic 4: Target payment policies to discourage avoidable adverse events.• Develop principles regarding avoidable adverse events using existing criteria from public and private payers.• Identify procedures, services, complications and outcomes that should be subject to an avoidable adverse events policy.• Implement avoidable adverse events payment policies to reduce and eliminate occurrences.• Establish metrics to evaluate effectiveness and value of avoidable adverse events policies.Tactic 5: Develop programs for preferred therapeutic drug substitution.• Identify best practices from national, sister states and private sector efforts.• Develop principles to guide adoption of drug utilization review methodologies to identify and monitor prescribing practices.• Address possible adverse reactions that some minority populations may have to certain drug interventions.• Review existing program policies to inventory current activities and compliance and identify cost effective opportunities.• Develop and implement programs of academic detailing and medication therapy management.• Create educational programs for new and existing practitioners and communications strategy for consumers.• Establish metrics to evaluate the effectiveness and value of preferred therapeutic drug substitution initiative.Proposed Milestones/MetricsWithin 6 months:• Payment reform stakeholder group’s membership appointed by the Council.Within one year:• Existing medical claims data utilization reviewed to determine areas of overuse, underused, misuse• Principles regarding avoidable adverse events established• Medicaid and private payer incentives identified• Financial incentives for e-prescribing, e-billing, e-health records and electronic eligibility verification identifiedWithin two years:• Establish payment policies that discourage underuse, misuse and overuse of services, products and procedures• Establish payment models to support PCMHs• Implement payment models to support PCMHsDecision Points1. What are the principles, values and criteria we should use to evaluate and choose payment reform models?2. What principles, values and criteria should be used to determine overuse, underuse, and misuse of medical services andprocedures?3. Are some payment reform models going to be implemented through regulation and, if so, which ones?4. If payment reform models are voluntary, how will we convince and work with payers to adopt the models we haverecommended?5. How will public and private payment reforms be aligned and coordinated?15