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Ohio Medicaid Managed Care Program
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Feedback from Individuals and Providers
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| ODM is planning to conduct a competitive managed care procurement and is interested in
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| hearing from individuals and providers about their experience with the current managed care system
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| and ideas for improving member and provider experience, service quality, and system accountability.
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| This OOA form is pulled from the original RFI and includes only the provider-specific portion. Originally, ODM had established a July 30 deadline. We have since been informed the response deadline has been extended indefinitely and additional responses are welcome.
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CONTACT INFORMATION
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| First Name: | |
| Last Name: | |
| Email: | |
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PROVIDER SUPPORT
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Standardization Across Managed Care Plans
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| 1. Provide suggestions about how ODM could promote greater consistency of prior authorization requirements across managed care plans (e.g., requiring all managed care plans to use the same state-developed prior authorization form, or having the state establish which services can/cannot be prior authorized), including the pros and cons, potential barriers, and ideas for addressing those barriers.
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| 2. Are there certain other functions or processes (e.g., provider oversight, quality measures, reporting) that should be standardized across managed care plans? If so, please identify:
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| • The function and how the function should be standardized
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| • The pros and cons of standardizing the function
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| • The potential barriers to standardizing the function and ideas for addressing them
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Communication About Policy Updates
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| 3. Describe your ideas for improving managed care plan communication with network providers about updates and changes to plan policies.
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Support For Administrative Requirements
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| 4. Describe how managed care plans could help providers navigate the plans’ administrative requirements, such as submitting clean claims and resolving billing issues. Have you had any experience with a managed care plan assisting you in these areas? If so, what was most helpful?
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Data Sharing
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| 5. How could data sharing between the state, managed care plans and providers be improved? In particular:
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| • What data do providers want access to that they do not have access to today; how would providers use that data?
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| • What is the most effective way of providing data to providers?
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| • Are there barriers to providing the requested data; how could those barriers be overcome?
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| • How could data be shared and used by providers that have limited resources and technology?
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Supporting Primary Care Providers
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| 6. Describe how managed care plans could support primary care providers in integrating care for individuals enrolled with them. In particular:
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| • What kind of primary care infrastructure may be needed?
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| • What kind of training or coaching may be needed?
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| • How could the state/managed care plans incentivize primary care providers to improve access to care?
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| • What kind of primary care models should be encouraged by the state/managed care plan?
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Workforce Development
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| 7. How could the state/managed care plans support workforce development for different types of providers, including dentists, pediatric psychiatrists, primary care providers, in-home providers and licensed or unlicensed behavioral health providers?
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Payment Innovation
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| 8. What are some ways the state/managed care plans could prepare and assist providers to move through the continuum of shared accountability models that reward providers for quality and improved health care outcomes? In particular:
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| • How could the state or managed care plans support and increase the establishment of comprehensive primary care practices and/or accountable care organizations?
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| • Are there other payment innovations that the state should consider incorporating into the Medicaid managed care program?
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Other
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| 9. What other suggestions do you have for ways the state/managed care plans could better support providers?
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