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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. 

Episode Program Updates

Episodes of Care Program Suspension for Calendar Years 2020 and 2021

Negative Incentive Payments for Calendar Year 2018

2019 and 2020 Episodes of Care Program Update