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Episode-based Payments
Episode-based payments is a part of quality-driven payment innovation programming in Ohio Medicaid.
Episode-based Payments

Episodes of Care


Ohio’s episode-based payment model seeks to reduce health care costs and improve quality of care by providing transparency on spend and quality across and entire episode, allowing providers new visibility into their performance and how they compare to peers. An episode of care includes all the care related to a defined medical event (e.g., a procedure or an acute condition), including the care for the event itself, any precursors to the event (such as diagnostic tests or pre-op visits) and follow-up care (such as medications, rehab, or readmission). Episodes, which are built from the perspective of a patient journey, offer a comprehensive view of the care involved in treating a condition for a patient.

Since 2015, Ohio has launched 43 episodes, 18 of which are currently tied to financial incentives. 

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Episodes of Care Program Updates
The Ohio Department of Medicaid recently announced several Episodes of Care program updates that include: Resuming the collection of 2018 negative incentives, Releasing 2019 Annual reports and incentives, and Suspending incentives for 2020, 2021 and 2022.
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