October 20, 2022

2022 Convention Highlights: Equity, Children’s Mental Health, Pinnacle Award Winners and More

Kelly O’Reilly, President and CEO, Ohio Association of Health Plans

Coming off another great Annual Convention & Trade Show, I’m excited to share some of the highlights for those who weren’t able to join us at the Sheraton Capitol Square in Columbus in September. It was a pleasure to reconnect with so many industry colleagues and we learned so much from our fantastic panels on some of the most critical issues in health care today — affordability, equity, children’s well-being, legislative issues and the future of biotechnology.

Speakers and Panels

Affordability: Three of Ohio’s top insurance brokers agreed that health insurance premiums are coming close to unsustainability for employers. They said that all players in the system share responsibility for finding solutions to the affordability problem but warned that employers already have maxed out their capacity through tools such as narrower provider networks, increased copays and deductibles, and carving out specialty drugs.

Equity: Panelists noted that it sits at the center of the Ohio Department of Medicaid’s Next Generation of Medicaid program now rolling out but noted that, until we can address the root causes of inequity, we must scramble to undo the damage to patients already harmed by it.

Our speakers reminded us how important it is to understand and address racism as a systemic problem because only systemic changes will have broad impact. We face a lot of difficult work ahead to ensure that our industry remains focused on diversity, equity and inclusion so that the momentum sparked by George Floyd’s death cannot be just a moment but a movement.

Children: Speakers from three of the state’s top advocacy groups — Groundwork Ohio, the Ohio Children’s Alliance and Children’s Defense Fund Ohio — left us with a renewed sense of urgency to partner with stakeholders, families, providers and schools to continue expanding access to mental health services for Ohio children.

We learned about innovative services such as therapeutic child care, featuring mental health clinicians embedded in child care settings to provide specialized care for children diagnosed with severe mental health challenges. The discussion also covered respite care for families of children with severe diagnoses, allowing their parents and caregivers the rest and recharging that can help such families succeed and avoid out-of-home placements.

Legislation: A panel of leaders and members of health and insurance-related committees as well as representatives of the Joint Medicaid Oversight Committee and Ohio General Assembly leadership discussed what lawmakers can do to make health care more affordable. They agreed that Ohio needs to think outside the box for ways to build the health care workforce — not just doctors and nurses, but the home health care providers and others so much in
short supply.

The future: David J. Staley, an associate professor at The Ohio State University and president of Columbus Futurists, said that in the future when we think of medical technology, it won’t be about a device but instead will involve biotechnology such as genetic coding. The implications he discussed are profound: Scientists already can create actual chicken meat from chicken stem cells, which could fundamentally change the nature of agriculture. He reminded us that humans always have modified plants and animals to serve our purposes; it’s just that what used to take centuries of careful breeding now can be accomplished in weeks. The breakthroughs that could come, such as the ability in the near future to create organs on demand via 3D printing, require us to go beyond simply asking whether something is technically possible. We’ll need to consider whether we should do the thing at all and how to ensure it is employed ethically.

Pinnacle Awards

As always at the Annual Convention, we took the opportunity to present this year’s Pinnacle Awards, recognizing two outstanding programs by which our member plans offer superior value to their members. The Pinnacle Award winners for 2022 are:

CareSource, for their respite care program in conjunction with the Child & Family Health Collaborative. To help families caring for a child with a behavioral health condition, a provider offers short-term child care in or out of the child’s home, giving a much-needed respite to parents or other caregivers. Along with relieving the stress and disruption that can harm a child’s brain development, respite care led to better outcomes. Families that received respite care were far less likely to file claims for emergency-department care, inpatient behavioral health services or day treatment. Even more important, the relief provided by the program helped avoid having children placed out of their homes or even out of state.

Paramount Health Care, for the CareSignal Disease Management Program. Paramount recognized that the lag time involved in collecting patient data limits its usefulness for helping individual patients improve their conditions. As a solution, Paramount checks on members in real time, using automated text messages or phone calls allowing those enrolled in the program to regularly report information on their depression, diabetes, chronic heart failure and COPD. Some also reported their status related to social determinants of health including lack of food, transportation or financial resources.

More than half of the 890 enrolled members who initially were categorized as high risk have been able to lower their risk level. Also, health educators reaching out to patients as a result of CareSignal data are much more likely to make a successful connection than those reaching out based on traditional claims data.

This gathering is a highlight of our year at OAHP, and we’re already thinking about the program we’ll put together for 2023. If you joined us in Columbus, thank you! And if you didn’t, we’ll keep you informed in the hope that we might see you next year.