What is the Ohio Quality Improvement Network (OQIN)?  

The OACHC has created a separate organization, (OQIN), whose mission will be to maximize the health and well-being of patients in its member communities through innovative, cost-effective care management practices and quality improvement activities through contracting relationships with health plans and health delivery systems. OQIN will be governed by a board elected by its members.

Why do I need to work with health plans?

FQHCs need to work more closely with health plans for the following reasons:

1. The state of Ohio has restructured its Medicaid program and using health plans to manage its Medicaid population. FQHCs will need health plan contracts to negotiate and receive reimbursement for its residents covered by both Medicaid and private insurers.
2. Health plans have expressed a strong preference to working with collaborative organizations, such as OQIN, rather than with individual FQHCs.

What are the benefits of joining OQIN?

1.  Joining OQIN will provide greater leverage in negotiating higher rates and other payment arrangements, such as pay for performance plans, with health plans. Individual health centers have less ability to negotiate and influence these rates and plans.
2. OQIN will provide educational and other resources to help your staff better understand how to maximize the payment components of the contracts, and to learn from other members regarding adoption of best practices and improving performance metrics.
3. OQIN will provide opportunities to apply for other types of innovative funding offered via the Centers for Medicare and Medicaid Innovation (CMMI), the state and other private grant opportunities.
4. OQIN will expand opportunities to accept more member patients from health plans as a result of a contractual relationship. Health plans may be reluctant to contract with a single facility, but will be more receptive to a network.

What services will OQIN provide?  

OACHC/OQIN has contracted with Strategic Health Care who will be responsible for contract negotiations, health systems relationships and educational resources for member facilities; credentialing and administrative support.

What will be my responsibilities as an OQIN member?

1. Adhere to an agreed upon percentage of contracts negotiated by OQIN, including compliance with billing, payment and data reporting responsibilities.
2. Submit necessary credentialing information required by the health plan; also meet or exceed OQIN’s application requirements.
3. Submit claims pursuant to health plan requirements.
4. Submit cost and performance data as required by OQIN to promote best practices across organizations.
5. Participate on OQIN board/committee structure as needed and participate in educational and training opportunities.

What is the cost of joining OQIN?

OQIN’s expenses have been limited to support only those activities that can directly benefit its member organization. OACHC has committed to supporting the initial development and administration of the network for six months until the OQIN board is established and organizational structure and documents are approved by the membership.

What are the potential cost benefit /return on my investment for joining OQIN?

FQHCs need to contract with health plans to be able to serve patients that are covered under Medicaid, the federal Exchange, a commercial health plan, or who have selected a Medicare Advantage product for their Medicare benefits.

OQIN offers a cost efficient way to contract with these health plans as a network to maximize reimbursement and obtain pay for performance plans. Administrative fees for joining the network can be more than offset through anticipated higher reimbursement rates negotiated by the OQIN versus a community health center that negotiates as a single entity or through other networks that charge a percent of claims. Facilities should also be able to expand their transitional care and increase revenues due to these expanded health plan relationships. Finally, the potential to negotiate payment incentives tied to quality and utilization incentives (e.g. reduced hospital readmissions) will further enhance the ROI to OQIN members.

How do I indicate my interest to join?  

Community health centers need to submit the OQIN Letter of Intent to Participate. To then join OQIN, an Operating Agreement and necessary documentation verifying the criteria for membership will need to be submitted to OQIN.