Episodes

Episode quick reference tables - A summary of key episode definition components for all episodes.

Detailed episode information
Definitions or concept papers, Detailed Business Requirements (DBR), and code tables for all episodes. Concept papers include an overall introduction to the episode rationale and design dimensions. DBRs include a more detailed definition as well as the associated coding algorithm. The code tables refer to an excel spreadsheet with the code detail for reach episode.

Wave 1:  Reporting for the initial set of episodes began in March of 2015.  For Medicaid, the performance period for asthma, COPD, and perinatal begins January 1st, 2016.  Episodes ending during the 12- month performance period will be used to determine whether or not a provider is eligible for an incentive payment.  Reporting will continue for all episodes.

 

Wave 2:  Reporting will begin for the episodes listed below in 2016.  The performance period for Wave 2 is scheduled to begin in 2017.

 

Wave 3: The following episodes are also planned for release in 2017:

Additionally, the following episodes are currently under development:

  •  Ankle sprain/strain
  •  Breast biopsy
  •  Breast cancer surgery
  •  Breast medical oncology
  •  Hip/pelvic fracture procedure
  •  Knee arthroscopy
  •  Knee sprain/strain
  •  Shoulder sprain/strain
  •  Spinal fusion
  •  Spinal decompression (without fusion)
  •  Wrist sprain/strain

Thresholding:  Overview of methodology used to set quality metric and spend thresholds and specific threshold values for Medicaid for asthma, COPD, and perinatal. 


Risk Adjustment Document:
 
Detailed description of principles and process of risk adjustment for episode-based payment model.

 

Episode Frequently Asked Questions

 

Guides:

How to Access Your Report

How to Read Your Report

How to Read Your PAP Referral Report


Sample Reports: Illustrative sample reports, intended to demonstrate format and content of future, actual episode reports.

Asthma (Fee-for-Service)

COPD (Fee-for-Service)

PAP Referral

Perinatal (Fee-for-Service)

Additional Resources

Episodes Overview
Background to health care payment innovation in Ohio, overview of episode-based payment model, summary definitions for perinatal, asthma, chronic obstructive pulmonary disease, total joint replacement, percutaneous coronary intervention (acute and non-acute) episodes.

Multi-Payer Episode Charter
Multi-payer charter describing payer alignment on design of episode-based payment model. 

Applications:
State Health Innovation Plan (October 2013)
State Innovation Model Test Grant Application (July 2014)

For more information on Ohio's Payment Innovation efforts, please visit the Governor's Office of Health Transformation.