The Ohio Department of Medicaid has released a Request For Information (RFI) for its managed care procurement program. We’ve submitted high-level comments to provide philanthropy’s perspective on ways in which the managed care process can be improved to ensure all Ohioans have full and equal access to opportunities to lead healthy lives.
July 24, 2019
Ohio Department of Medicaid
Office of Contracts and Procurement
Managed Care Procurement RFI
PO Box 182709
Columbus, Ohio 43218-2709
ATTN: RFP/RLB Unit
Dear Director Corcoran,
Philanthropy Ohio is pleased to submit comments in response to the managed care procurement RFI. We appreciate the vast undertaking the RFI represents and especially appreciate its three-fold focus:
- Improve the quality of service and care;
- Use best practices to expand service and improve health outcomes; and
- Improve the provider experience.
We applaud you for taking on this significant work and feel confident it can lead to continued evolution of care systems that are able to improve the health of our state’s residents.
Since 2010, the Philanthropy Ohio Health Initiative has been a member-driven coalition focused on health policy reform that improves the health of all Ohioans. The Health Initiative envisions a future where the health system and Ohio communities, supported by philanthropy, promote health and disease prevention and work to achieve health equity. Such a future is built upon these principles, which we hope you share:
- Ohio’s health system, communities and philanthropy promote health and wellness with a specific focus on prevention.
- Ohioans make informed choices about coverage and care that lead to healthy behaviors.
- Social, economic and physical environments support improved health of all Ohioans.
- Ohioans have full and equal access to opportunities enabling them to lead healthy lives.
We seek to promote this future by employing three strategies:
- Building relationships with policymakers, including the Governor, the General Assembly, members of Congress and key state agencies;
- Educating funders on current health issues and policies at the state and federal levels; and
- Advocating for policies to address the social determinants of health, increase equity and improve the health of all Ohioans.
It is from this vantage point that we submit our comments related to the managed care procurement process, asking you to consider our viewpoints and perspectives as you craft changes that meet your goals. So many critical health issues in the state – from the substance use disorder crisis to appalling infant mortality figures to widespread disparities in numerous health outcome measures – can be addressed through a managed care system that helps Medicaid-insured individuals and families access the care and resources needed for healthier lives.
Use the State Health Improvement Plan to inform decisions
Since the 2016 state health assessment documented the health and well-being of Ohioans, the state has developed and is implementing a state health improvement plan (SHIP). The SHIP is a strategic roadmap that outlines the priorities, objectives and evidenced-based strategies to address three of the state’s greatest health challenges: mental health and addiction, chronic disease and maternal and infant health. The 2017 – 2019 SHIP builds on the previous plan and it is our recommendation that not only will you use it to guide the procurement process but that the Ohio Department of Health will lead the development of the next plan, with participation from the Ohio Department of Medicaid and other health-related state agencies and other key stakeholders.
Focus on the social determinants of health
Recent work by the Health Policy Institute of Ohio and others suggests that an individual’s health is driven less by clinical factors and more by factors outside the doctor’s office. This recent research emphasizes that clinical care is responsible for a relatively small (20 percent) portion of health outcomes while social determinants—like education and housing – are responsible for 50 percent, reinforcing the need for a deliberate and strong focus on social determinants. Early learnings from use of the Accountable Health Communities model (supported by the Center for Medicare and Medicaid Innovation grants), including one in Cincinnati that is documented in a briefing paper by bi3 (Addressing the Social Determinants of Health, Summer 2019), can inform and identify ways that health care and community-based organizations can partner to address social determinants and make deeper impacts on health outcomes.
Address health disparities and aspire for equity
Data clearly show that Ohioans of color do not have the same opportunity as do white Ohioans to live healthy lives:
- Black infants are dying at nearly three times the rate of white infants in Ohio;
- Overall health status for black and Hispanic Ohioans is 1.3 time worse than that of white Ohioans; and
- Black Ohioans have higher rates of obesity, hypertension and childhood obesity.
Improving the health outcomes for Ohioans necessitates recognizing the disparities by race/ethnicity, geography and other demographic factors and closing the gaps so that all Ohioans have an equal opportunity to live healthy lives. We encourage the department to consider ways in which the procurement process and managed care systems can reduce the disparities that so many Ohioans experience.
Track and use comprehensive health outcomes data
We cannot emphasize enough the need for the collection, analysis, dissemination and use of comprehensive health outcomes data at the state and local level. The department should consider the ways in which managed care providers can consistently and comprehensively compile and report outcomes for their patients in a transparent and effective way.
In addition to these key priorities we have discussed above, we would also note our concerns for how this process can focus on assuring that: patients have continuity of care, particularly as you consider specialty care for specialty populations; that care takes a holistic approach to an individual’s health; and that the approach to managed care is viewed within the broader context of the department’s work, including the promulgation of upcoming rules and regulations related to the 1115 Waiver and its work requirements.
We hope that these comments and perspectives are helpful in the department’s process and stand ready to answer any questions and assist as it moves forward. Thank you for your consideration and please do not hesitate to contact me.
Claudia Y.W. Herrold
Interim President & CEO
Senior Vice President, Communications and Public Policy