Better insights lead to better outcomes.

Driving Better Outcomes

Improved health outcomes takes a commitment to growth and innovation, and Ohio’s health plans are on board.
OAHP members use an array of tools, such as creative partnerships, emerging technologies and direct member engagement, to achieve better health outcomes for Ohioans. Plans measure outcomes data to determine what efforts prove most effective so that they can be replicated and expanded across the state.
88%
Concierge Care
Reduction in IBD-related Emergency Room visits by members with Crohn’s disease as a result of their participation in Anthem Blue Cross Blue Shield’s Concierge Care Program. Furthermore, 65% of members with ER visits 12 months prior to enrollment in the program had no ER visits in six months following the enrollment.
0
Rural Nurse Navigator Program
Number of NICU deliveries among women supported by Buckeye Health Plan’s Rural Nurse Navigator Program, a partnership with Ohio University to address maternal health needs in five rural counties in southeast Ohio. By comparison, 3.7% of births by women in the region resulted in NICU support.
15%
At Your Service
Reduction in Emergency Room utilization among Molina Healthcare members supported by the new “Molina At Your Service” program, a member and provider concierge program designed to help enhance programs and improve quality of care.
100%
Remote Monitoring
Percentage of members at high risk of chronic heart failure that showed improvements in their risk level while enrolled in CareSignal, Paramount Health Care’s remote monitoring program aimed at helping members to manage chronic conditions.
12
Concierge Care
Number of weeks that members enroll in Blue Cross Blue Shield’s Concierge Care Program, a chronic disease management program that enables care managers to build personalized care plans and supports member needs to improve overall health.
32%
Rural Nurse Navigator Program
Improvement in pre-term birth rate (8.3% from 12.2%) for women supported by Buckeye Health Plan’s Rural Nurse Navigator Program, a partnership with Ohio University to address maternal health needs in five rural counties in southeast Ohio.
1,000
At Your Service
Number of outreach calls Molina Healthcare has made to members and providers as part of “Molina At Your Service,” a member and provider concierge program designed to help enhance programs and improve quality of care.
88%
Respite Care
Decrease in acute services usage among members and families within six months of receiving respite care in the CareSource/Child and Family Health Collaborative Behavioral Health Respite Care Program.
67%
Respite Care
Reduction in behavioral health inpatient services volume for members enrolled in the CareSource/Child and Family Health Collaborative Behavioral Health Respite Care Program. This resulted in a 77% decline in inpatient services spend.
70%
Remote Monitoring
Percentage of members at high risk of depression that showed improvements in their risk level while enrolled in CareSignal, Paramount Health Care’s remote monitoring program aimed at helping members to manage chronic conditions.
$975,000
Columbus Speech & Hearing
Grant in 2022 from Ohio’s Medicaid managed care plans — Anthem, Buckeye, CareSource, Molina and UnitedHealthcare — to support the nonprofit’s Early Identification and Intervention program, providing follow-up evaluations, referrals, and speech-language therapy and audiology services to additional children in the central Ohio community.
$0
Special Skills Sports Camps
Cost for Ohioans with special needs to attend Special Skills Sports Camps, supported in part by a 2022 contribution from Ohio’s Medicaid managed care plans — Anthem, Buckeye, CareSource, Molina and UnitedHealthcare.
42
Ronald McDonald House Charities of Dayton
Number of guest rooms in the new Ronald McDonald House Charities of Dayton lodging facility, supported by a $13 million donation from Ohio’s Medicaid managed care plans — Anthem, Buckeye, CareSource, Molina and UnitedHealthcare.

White Papers or Case Studies from Our Members

New thought leadership from OAHP member organizations.

NantHealth: Health Plans Navigate Unsustainable Cancer Costs and Ever-Evolving Therapies

The burden of cancer is heavy on patients, providers, and payers. Nearly 40 percent of men and women will be diagnosed with cancer at some point during their lifetimes.

It’s one of the leading causes of death in the United States, and the direct and indirect costs of cancer are staggering. The National Cancer Institute estimates that cancer-related direct medical costs in the United States were $183 billion in 2015 and projected to increase to $246 billion by 2030, a 34% increase based on population growth and aging. The projection is likely an underestimate because of the increasing cost of medications to treat cancer, with the list price for many cancer drugs exceeding $100,000 annually.

As drug prices rise and the overall expense of cancer care increases, unnecessary or inappropriate cancer therapy has never been more costly.

In the white paper, Health Plans Navigate Unsustainable Cancer Costs and Ever-Evolving Therapies, we outline new ways payers can reduce and manage the costs of cancer while driving positive outcomes for their members, their provider network, and their business processes to ultimately enable the highest standard of evidence-based care.

NantHealth builds technology that simplifies healthcare. Managing the data and decisions that help the industry deliver better care, NantHealth empowers payers and providers to make more confident decisions, improve care collaboration, and boost efficiency. Our payer-provider collaboration solutions (NaviNet) increase operational efficiency, unlock savings, and enhance communications. Our treatment plan validation capabilities (Eviti Connect) help payers better manage costs for oncology and autoimmune conditions through a streamlined authorization workflow that facilitates expedited care for members. For more information, visit nanthealth.com, follow us on Twitter, Facebook, LinkedIn and YouTube and subscribe to our blog.

Please note:  This information represents the views of the author, not the Ohio Association of Health Plans (OAHP).  The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.

Since 2021, MedArrive has been partnering with Molina Healthcare to improve health outcomes and reduce unnecessary ED and Hospital utilization for an underserved population of members with complex Medical and SDOH needs in Texas.  To learn more and view the program results, read the MedArrive case study.

Please note:  This information represents the views of the author, not the Ohio Association of Health Plans (OAHP).  The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.

Landmark originally partnered with Bamboo Health in 2018 across its New England locations. The team soon saw the value of efficient post-discharge follow up workflows as well as freed up time and resources now that they no longer had to chase down patient locations by calling facilities or the patients directly, and instead had the data readily available from Pings.  As a result, the Pings solution was launched across five additional states: North Carolina, Ohio, Kansas, Missouri, and Texas.

The Landmark team leverages Bamboo Health’s Pings product for real-time notifications on patients’ care events, which are received via SMS, email, and on the Pings web application. The team also uses the Ping’s solution’s Saved Filters, Exports, COVID-19 Flag, Readmission Risk Flag, and 3-Day Waiver Flag features. To date, 170+ Landmark users leverage the platform, including care coordinators, nurses, physicians, and pharmacists.  To learn more, read the  Bamboo Health case study.

Please note:  This information represents the views of the author, not the Ohio Association of Health Plans (OAHP).  The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.

Xcenda | Life Sciences Commercialization & Consulting is a leading team of value experts, transforming evidence and market intelligence into effective global market access strategies and solutions.  Novartis commissioned Xcenda to prepare white paper on the state of ASCVD in the US and the need for continued innovation to treat ASCVD.

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States and the underlying cause in about 50% of all deaths in Western societies.  It is known more commonly by its myriad of negative outcomes, including myocardial infarction (MI), angina, stroke/transient ischemic attack, peripheral artery disease, heart failure, and atrial fibrillation, than by the collective term ASCVD.

Approximately, 60% of deaths due to ASCVD occur in people aged ≤65 years old, over 1,000 deaths per day are caused by ASCVD related events, and the age-adjusted death rate for it is 219.4 per 100,000 people in 2017.

Beyond healthier diets, smoking cessation, and other cardiovascular disease (CVD) prevention methods, treatment options exist that target the main risk factors for ASCVD development, primarily HBP, high low-density lipoprotein cholesterol (LDL-C), and diabetes. But control of these diseases remains poor in the US (while prevalence continues to increase), and access challenges, clinical inertia, and poor adherence are barriers to effective prevention and treatment.

Improving outcomes will require a multifactorial approach, with players in all parts of the healthcare system working to identify risk factors, minimize or reverse the increasing prevalence of certain diseases, and effectively treat these diseases with all the tools available to us.  Like other chronic conditions, this will require a team-based medical approach with shared decision making.

To learn more read the Novartis white paper on the state of Atherosclerotic cardiovascular disease (ASCVD) in the US and the need for continued innovation to treat ASCVD.

Please note:  This information represents the views of the author, not the Ohio Association of Health Plans (OAHP).  The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.

Sellers Dorsey is a national health care consulting firm that helps clients navigate the ever-changing health care landscape by providing a range of consulting services in Medicaid, as well as custom Medicaid financing solutions.  Since 2000 we have consulted on a range of financing, policy, and operational projects in nearly 40 states, delivering a fully integrated suite of services to a wide array of clients.  We help clients in multiple areas of expertise, such as delivery system reform, Medicaid financing, program administration, quality improvement strategies, and health care advisory.  Sellers Dorsey is home to former state Department of Human Services and Medicaid officials, former Medicaid directors, and industry executives with expertise in the development and implementation of reimbursement, financing, administration, and quality improvement strategies, along with highly qualified project management and research staff.  Our team’s diverse background enables us to appreciate and navigate each client’s unique path to success.

Sellers Dorsey on behalf of Pyx Health has provided a white paper study on Banner University Health Plans, Arizona (BUHP), which covers over 200,000 Medicaid, Dual Eligible Medicare, and Long-Term Care lives.  In 2018 Arizona integrated behavioral health care into their traditional Medicaid program.  This prompted BUHP to search for new approaches to address the whole-person needs of their members with a focus on key drivers of avoidable utilization—behavioral health conditions and social barriers to care.  The purpose of the study was to analyze the utilization patterns and medical expense of both general mental health conditions, such as anxiety and depression, and serious mental illness on increased medical expenditures, including general hospital admissions and emergency department use.  To learn more read the Pyx Health Expands Banner University Health Plans’ 24/7 Care Team To Decrease Medical Spend Among High-Utilizing Members white paper.

Please note: This information represents the views of the author, not the Ohio Association of Health Plans (OAHP). The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.

Sarepta Therapeutics is at the forefront of precision genetic medicine, having built an impressive and competitive position in Duchenne muscular dystrophy (DMD) and more recently in gene therapies for 6 Limb-girdle muscular dystrophy diseases (LGMD), Charcot-Marie-Tooth (CMT), MPS IIIA, Pompe and other CNS-related disorders, totaling over 20 therapies in various stages of development.  The Company’s programs and research focus span several therapeutic modalities, including RNA, gene therapy and gene editing.  Sarepta is fueled by an audacious but important mission: to profoundly improve and extend the lives of patients with rare genetic-based diseases.

The purpose of the Sarepta Therapeutics white paper is to provide a rational and feasible approach to monitoring patients with Duchenne muscular dystrophy (DMD) in a clinical setting to better assist providers and insurers in assessing response to treatment compared to the natural history of DMD.  Patient groups with different genetic mutations vary in their expected rates of decline, so genotype-specific natural history should inform evaluations when available.  To learn more, read the Outcome Measures for Patients With Duchenne Muscular Dystrophy white paper.  For additional information or questions you may contact Kristie Bryerton, Director of National Accounts for Sarepta Therapeutics.  Ms. Bryerton may be reached electronically at: kbryerton@sarepta.com or by phone: (570) 916-3247.

Please note: This information represents the views of the author, not the Ohio Association of Health Plans (OAHP). The publication, distribution or posting of this information by OAHP does not constitute a guarantee of any product or service by OAHP.

Health Care Glossary

Health care terminology can often be confusing. Empower yourself to learn more with this helpful guide.

A person who receives benefits of any insurance plan or policy.

An employee or other insured named under a group health insurance policy.

A request for payment for services.

A specified dollar amount or percentage of covered expenses that an insurance policy or Medicare requires a beneficiary to pay toward eligible medical bills.

Federal law requiring that workers who end employment for specified reasons have the option of purchasing group insurance through the employer for a limited period of coverage (usually 18 months, but in some cases, 29 months or 36 months).

Provisions and procedures used by insurers to avoid duplicate payments when a person is covered by more than one policy.

Services for which an insurance policy will pay.

A specified dollar amount of medical expenses that the beneficiary must pay before an insurance policy will pay.

A procedure or condition that an insurance policy does not cover.

Medical treatment that is not generally accepted within the medical profession. Insurance policies often do not cover these procedures.

A statement from an insurance company showing which payments have been made on a claim.

Traditional insurance that does not place restrictions on which doctors you can use. The insurer pays for the expense incurred.

A contract between an insurer and an employer or association.

Federal law that guarantees health care plan eligibility for people who change jobs if the new employer offers group insurance.

A term for managed care insurers in Ohio. HICs include all Ohio HMOs and other companies that offer prepaid managed care.

A contract between an insurance company and an insured person.

A person who has been admitted to a hospital or other health care facility to receive diagnosis, treatment or other health services.

An individual or organization protected by an insurance policy.

The medical and social care given to one who has a severe chronic impairment over a long period of time.

A term traditionally confused with the term HMO. A general term used to describe a system that focuses on improving quality and controlling prices. Managed Care includes HMOs, PPOs and POS plans.

Treatments or services an insurance policy will pay for as defined in the contract.

A period of time when new subscribers may enroll in a health insurance plan regardless of their health.

A patient who receives care at a hospital or other health care facility without being admitted to the facility. Outpatient care also refers to care given in other locations such as outpatient clinics.

Requires an insured to obtain the insurance company’s approval before a medical service is provided. If the insured fails to follow the pre-certification procedures, the company may reduce or deny claim payment. Getting pre-certification does not guarantee claim payment.

Money paid in advance for insurance coverage.

Health insurance policy that pays first when a person is covered by more than one insurance plan.

A person or organization that provides medical services, such as a doctor, hospital, x-ray company, home health agency, pharmacy, etc.

Applies only when the insured has more than one health insurance plan. The secondary payer is the plan whose payments cannot be made until another plan (the primary payer) has processed the claim. (Also see Coordination of Benefits)

An organization (usually an employer) that pays health care costs out of the organization’s own pocket.