MyCare Ohio Duals Demo Average Claim Cost PMPM Drops 6.8%

In the third year of the Ohio Medicaid dual eligible demonstration, MyCare Ohio, the state reported that average claims costs per member per month (PMPM) dropped by 6.8% from January 2015 to the end of December 2016.  Across this period, the trend in MyCare Ohio capitation rates slid from about 2% higher than fee-for-service (FFS) rates in January 2015 to about 5% lower than FFS rates at the end of December 2016. This trend was attributed to the MyCare managed care organizations' (MCOs’) efforts to divert individuals from nursing facility settings to home- and community-based settings . . .