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, 23 of which are currently tied to financial incentives. 11 episodes have been retired starting the 2019 program year and two additional in 2020.
2019 and 2020 Episodes of Care Program Update
Episodes Quick Reference
Medicaid Quality Metric and Spend Threshold Overview and Methodology
Episode Risk Adjustment Document
Episode Frequently asked Questions