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Ohio’s Vision for Sustainability

Ohio’s Vision for Sustainability. ANCOR Fall Leadership Summit October 24, 2011. Increased Pressure for Resources. Increased demand for services 27,000 on waiting list Direct support professional crisis Wages Benefits Turnover Decreased Resources $ 8B deficit Inflation. Tools.

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Ohio’s Vision for Sustainability

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  1. Ohio’s Vision for Sustainability ANCOR Fall Leadership Summit October 24, 2011

  2. Increased Pressure for Resources • Increased demand for services • 27,000 on waiting list • Direct support professional crisis • Wages • Benefits • Turnover • Decreased Resources • $8B deficit • Inflation

  3. Tools • No HCBS DD waiver provider rate cut • 1.5% reduction in per member per month (pmpm) • 3% voluntary reduction in service utilization • Managed care • Role in our system • Patient-Centered Medical Home - ACO • Waiver reimbursement pilot • Leverage

  4. Patient-Centered Medical Home - ACO • Patient-Centered Medical Home • Geography or diagnosis • IADD-specific • Current coordination • Partnerships • Possible role of IADD providers • Primary medical care and health home services • Health home services • Subject Matter Expert (SME) • Memorandum of Understanding (MOU) • Affordable care organization

  5. Waiver Reimbursement Pilot • 15 minute rate • Misaligned incentives • Realignment of incentives by state, county boards and providers • Same or improved outcomes – shift focus from inputs to outcomes • Better manage expense • Decrease administrative expense

  6. Possible Pilot Model • Weekly rate • Acuity based case rate • Utilization adjusted • Efficiency dividends for state, counties, people on waiting lists and providers • Service planning • Oversight role • Quality • Access • Cost

  7. Why a Pilot? • “If we knew it would work, we wouldn't need a pilot.” • Dynamic • Collaborative • Longer view

  8. Leverage • Shared service models • Acquisitions and mergers • Collaboratives • Member services • Strange bedfellows

  9. Thank You! Mark Davis Ohio Provider Resource Association 1152 Goodale Boulevard Columbus, Ohio 43212 614.224.6772 mdavis@opra.org

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