An Evolving Health Reform Landscape – Part 4 of 4

by Mark A. Ridenour of the Ridenour Group, Consultant to the Ohio Optometric Association

There are numerous other delivery and payment reform pilot projects currently happening or planned generally. The pilots are funded by state and/or federal grants.  As an illustrative example, note the following activity just in Ohio.  Innovation grants for coordinated pediatric care were awarded to University Hospitals of Cleveland and Nationwide Children’s (Columbus) earlier this year.  MetroHealth (Cleveland) was granted a waiver to deliver Medicaid-like benefits to a local uninsured population, although this project has yet to launch.  Governor Kasich submitted a grant application for a federal State Innovation Model (SIM) to extend Medical Homes and facilitate payment reform via episode-based modules (e.g. a single payment for the care and rehabilitation of knee replacement).

Each of these delivery and payment system changes (Medical Homes, ACOs, bundled payment models, and other initiatives) modifies the flow of patients and/or funds. If Optometry is not actively engaged and promoting its value, the results are likely to mean less of both.  The good news is that, as the primary eye care provider, your services align with the general shift of investment to primary/preventive care.  An efficient exchange of data inter-professionally will be key to each of these initiatives.  Therefore, your EHR capabilities and willingness to participate should provide the necessary advantage to avoid exclusion.

At least in the interim, and perhaps for the longer term, there will be variation in how these shifts manifest locally.   In Ohio, the Ohio Optometric Association has identified key relationships for each of these pilots and has engaged administration and key optometrists in the planning and design wherever possible.   While the scope of this is very broad, impacts are felt at a local level.  Be cognizant of change within your inter-professional community and, as always, contact Ohio Optometric Association for support.

“An Evolving Health Reform Landscape” is a four-part series.

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