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The Ohio Department of Medicaid’s (ODM) Population Health and Quality Strategy 2026–2028 (Draft, April 14, 2025) lays out a structured, values-driven roadmap to improve health outcomes, person-centered care, support providers, address the needs of complex populations, and enhance transparency. It aligns closely with the CMS National Quality Strategy priorities and embeds a Stairstep Population Health Management Framework to drive data-informed action. The comprehensive integration of behavioral health, physical health, and social determinants of health (SDOH) positions Ohio to more effectively close longstanding equity gaps. To ensure success, ODM should deepen community engagement, publish transparent, disaggregated performance metrics, and target resources, especially in rural and underserved urban areas using a needs-based allocation model.
ODM maps its five overarching goals to the CMS National Quality Strategy’s domains better care, healthy people/healthy communities, and smarter spending ensuring state initiatives reinforce federal priorities. Because this alignment leverages established national benchmarks, ODM can more readily benchmark progress and learn from other states’ best practices. The draft foregrounds six core values innovation, collaboration, stewardship, accountability, integrity, and passion to guide every strategy and measure. Embedding these values fosters a shared vision among state agencies, managed care entities, providers, and community partners, which is essential for cohesive, system-wide change. By requiring managed care entities to conduct comprehensive health risk assessments, stratify risk, and track a uniform set of quality measures (including HEDIS, CAHPS, and program-specific metrics), ODM ensures that care is both personalized and data-driven.
The framework explicitly integrates behavioral health, physical health, and Social Determinants of Health (SDOH) interventions such as food, housing, and transportation supports into managed care contracts, reflecting evidence that addressing social needs improves clinical outcomes. ODM sets minimum performance standards not only for the overall Medicaid population but specifically for the Black population, a concrete step toward narrowing racial disparities.
Linking performance metrics to both the Ohio Opportunity Index and the Children’s Opportunity Index further allows identification of geographic areas of need, enabling targeted interventions. While the draft mentions stakeholder input, further improvements can establish formal Community Advisory Boards at least one per Public Use Microdata Area (PUMA) with clear charters and decision-making roles.
These boards would ensure bidirectional feedback, cultural relevance of interventions, and early detection of emerging local challenges. Transparent, timely reporting builds public trust and pressures managed care entities to innovate and improve.
Adopting a formal resource-allocation model that ties funding and technical assistance to counties’ composite scores on the Ohio Opportunity Index and the state’s rural-urban continuum.
Integrating social services data streams into Medicaid claims analytics will enable rigorous evaluation of SDOH interventions on health outcomes. Forming a quarterly Quality Strategy Governance Council with senior leadership from ODM, the Ohio Departments of Health and Mental Health & Addiction Services, managed care plans, provider associations, and community-based organizations will be useful in gaining continuity across programs.
The 2026–2028 Population Health and Quality Strategy draft is a comprehensive, thoughtfully structured blueprint that, if fully implemented, can drive measurable improvements in Ohioans’ health and equity. By deepening community engagement, making performance data publicly accessible, allocating resources based on documented need, and scaling evidence-based social determinant interventions, ODM can translate its ambitious vision into lasting impact. Thank you for the opportunity to provide feedback on this vital initiative.
