Episodes

Episode quick reference tables - A summary of key episode definition components for all episodes.

Detailed episode information
Definitions or concept papers, Detailed Business Requirements (DBR), and code tables for all episodes. Concept papers include an overall introduction to the episode rationale and design dimensions. DBRs include a more detailed definition as well as the associated coding algorithm. The code tables refer to an excel spreadsheet with the code detail for reach episode.

Wave 1: Reporting for the initial set of episodes began in March 2015. For Medicaid, the first performance period for asthma exacerbation, COPD exacerbation, and perinatal episodes was January 1st, 2016 to December 31st, 2016; subsequent performance periods will continue with each calendar year. Episodes ending during each 12-month performance period will be used to determine whether or not a provider is eligible for an incentive payment. Reporting will continue for all episodes.

 

Wave 2: Reporting for the initial set of episodes began in March 2016. For Medicaid, the first performance period for cholecystectomy, colonoscopy, esophagogastroduodenoscopy (EGD), gastrointestinal bleed, upper respiratory infection (URI), and urinary tract infection (UTI) episodes was January 1st, 2017 to December 31st, 2017; subsequent performance periods will continue with each calendar year. Episodes ending during each 12-month performance period will be used to determine whether or not a provider is eligible for an incentive payment. Reporting will continue for all episodes.

 

Wave 3: The following episodes are also planned for release in 2017:

Thresholding:  Overview of methodology used to set quality metric and spend thresholds and specific threshold values for Medicaid for asthma, COPD, and perinatal. 


Risk Adjustment Document:
 
Detailed description of principles and process of risk adjustment for episode-based payment model.

 

Episode Frequently Asked Questions

 

Guides:

How to Access Your Report

How to Read Your Report

How to Read Your PAP Referral Report

 

Sample Reports: Illustrative sample reports, intended to demonstrate format and content of future, actual episode reports.

Asthma (Fee-for-Service)

COPD (Fee-for-Service)

PAP Referral

Perinatal (Fee-for-Service)

Additional Resources

Episodes Overview
Background to health care payment innovation in Ohio, overview of episode-based payment model, summary definitions for perinatal, asthma, chronic obstructive pulmonary disease, total joint replacement, percutaneous coronary intervention (acute and non-acute) episodes.

Multi-Payer Episode Charter
Multi-payer charter describing payer alignment on design of episode-based payment model. 

Applications:
State Health Innovation Plan (October 2013)
State Innovation Model Test Grant Application (July 2014)

For more information on Ohio's Payment Innovation efforts, please visit the Governor's Office of Health Transformation.