Quality Strategy

Ohio Medicaid’s Quality Strategy is central to guiding the agency’s ongoing mission to provide residents improved health outcomes through innovation. The Department of Medicaid is taking a population health approach to achieve this goal by grouping the Medicaid population into the following streams: Healthy Children and Adults, Women’s Health, Behavioral Health, and Chronic Conditions. Through innovative payment arrangements, quality improvement partnerships, and data each population stream’s desired health improvements will be achieved.

This document outlines the various ODM initiatives that are helping Ohio Medicaid to achieve its goals and continue to reform the health care landscape across Ohio.

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Quality Measures
Measures Description
SFY 2018 External Quality Review Technical Report The annual external quality review technical report provides an evaluation of the accessibility, quality, and timeliness of services that Ohio’s Medicaid Managed Care Plans provided to their enrolled consumers. These reports were produced by ODM’s external quality review (EQR) organization, Health Services Advisory Group, in order to comply with federal EQR requirements cited at 42 CFR 438.364.
The Health Plan Accreditation Status for Ohio’s Medicaid Managed Care Plans Medicaid managed care plans (MCPs) and MyCare Ohio Plans (MCOPs) are required to achieve and maintain an acceptable health plan accreditation status awarded by the National Committee for Quality Assurance (NCQA) for the Ohio Medicaid line of business. Each year, the Ohio Department of Medicaid evaluates Plans’ performance on this requirement. NCQA accreditation information, as well as current NCQA accreditation status and expiration date for each contracted plan as of November 2018, are provided in the Health Plan Accreditation Status for Ohio’s Medicaid Managed Care Plans document.
The 2018 Ohio Department of Medicaid (ODM) Managed Care Quality Strategy (2018 Submission CMS) Pursuant to 42 CFR 438.340, the Ohio Department of Medicaid’s Managed Care Quality Strategy has been submitted to CMS for Review. The Quality Strategy documents Ohio Medicaid’s approach to assessing and improving the quality of health care and services furnished by contracted managed care plans to their members.
The Health Plan Accreditation Status for Ohio’s Medicaid Managed Care Plans Document description: Medicaid managed care plans (MCPs) and MyCare Ohio Plans (MCOPs) are required to achieve and maintain an acceptable health plan accreditation status awarded by the National Committee for Quality Assurance (NCQA) for the Ohio Medicaid line of business. Each year, the Ohio Department of Medicaid evaluates Plans’ performance on this requirement. NCQA accreditation information, as well as current NCQA accreditation status and expiration date for each contracted plan as of December 2017 are provided in the Health Plan Accreditation Status for Ohio’s Medicaid Managed Care Plans document.
SFY 2018 HEDIS Aggregate Report for the Ohio Medicaid Managed Care Program Ohio Medicaid quality measures assess Managed Care Plan performance in key program areas (i.e., access, clinical quality, consumer satisfaction). The report shows results of these measures by managed care plan and statewide, grouped by population stream: Healthy Children, Healthy Adults, Women's Health, Behavioral Health, and Chronic Conditions.  Individual managed care plan and statewide measure results are trended over a 5-year period and evaluated for comparison to national Medicaid benchmarks.
SFY 2017 External Quality Review Technical Report The annual external quality review technical report provides an evaluation of the accessibility, quality, and timeliness of services that Ohio’s Medicaid Managed Care Plans provided to their enrolled consumers. These reports were produced by ODM’s external quality review (EQR) organization, Health Services Advisory Group, in order to comply with federal EQR requirements cited at 42 CFR 438.364.
SFY 2016 External Quality Review Technical Report
2014 Adult Medicaid Quality Measures CMS established an Initial Core Set of Measures for Adults in Medicaid in January 2012.  Medicaid was awarded a grant to test and evaluate methods for collection and reporting results to CMS. This is Ohio’s report on selected measures from the initial core set of measures.
2017 MCP CAHPS Executive Summary Report Medicaid managed care plans (MCPs) and MyCare Ohio Plans(MCOPs) are required to conduct annual surveys of member experience and satisfaction with care using an independent survey organization. Ohio Medicaid issues three Program-specific reports each year to provide a comprehensive analysis of the data. A high-level overview and key findings are contained in an Executive Summary Report, while detailed analyses and findings are presented in a Full Report. A Methodology Report offers a detailed description of the analytical methodology.  Note - the Methodology Report was not produced for the MyCare Ohio Program for 2015.
2017 MCP CAHPS Full Report
2017 MCP CAHPS Methodology Report
2015 MCOP CAHPS Executive Summary Report
2015 MCOP CAHPS Full Report
2014 Ohio Medicaid Managed Care Quality of Life Survey In 2014, the Ohio Department of Medicaid administered a Quality of Life Survey to the Aged, Blind, or Disabled (ABD) and Covered Families and Children (CFC) child populations enrolled in managed care. The 2014 Ohio Medicaid Managed Care Quality of Life Survey shows results by  managed care plan and statewide.