Ohio Healthcare Analytics

Healthcare Analytics for Ohio Hospitals and Clinics

Ohio recorded more than 5,300 opioid overdose deaths in 2022, a readmission rate 2.1 percentage points above the national average, and a rural Appalachian region where hospital access is disappearing as Rust Belt communities age. Ohio health systems must simultaneously manage the nation's most acute opioid crisis, Ohio Medicaid managed care performance requirements, and the long-term financial sustainability of facilities in economically distressed communities.

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5,300+Opioid overdose deaths in Ohio in 2022 — among the highest in the US
Ohio Healthcare Landscape

Ohio's Healthcare Data Challenge

Ohio's 200+ acute care hospitals operate in a market shaped by two distinct forces: a globally recognized academic medical center sector — led by Cleveland Clinic (22 hospitals, internationally recognized for cardiac and cancer care), OhioHealth, ProMedica, University Hospitals Cleveland, and Kettering Health — and a rural Appalachian Ohio region where Summa Health, Premier Health, and smaller community hospitals face chronic financial pressure from aging populations, declining payer mix, and workforce shortages. The contrast between Cleveland's world-class medical infrastructure and the healthcare deserts of Appalachian Ohio captures the analytics challenge facing the state's health system leaders: how to sustain rural facilities while maintaining quality performance standards driven by the most competitive urban market in the Midwest.

Ohio's opioid epidemic peaked with more than 5,300 overdose deaths in 2022, and while that number has begun declining, the legacy of a decade of overdose crisis is a Medicaid population with elevated rates of hepatitis C, infective endocarditis, and neonatal abstinence syndrome that create disproportionate inpatient utilization. Ohio hospitals have a 30-day readmission rate approximately 2.1 percentage points above the national average — a gap that translates directly into CMS HRRP penalties and suppressed Hospital Value-Based Purchasing (HVBP) scores that affect total reimbursement on every Medicare inpatient case.

200+
Acute care hospitals across Ohio
5,300+
Opioid overdose deaths in Ohio in 2022
+2.1%
OH readmission rate above national average
3.4M+
Ohio Medicaid enrollees
How Vizier Helps

Ohio-Specific Analytics Solutions

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Readmission Penalty Reduction
Ohio's readmission rate sits above the national average, generating outsized HRRP penalties. Vizier identifies the specific DRG and patient cohorts driving excess readmissions at each facility — stratifying by SUD status, housing instability, and post-acute follow-up adherence — so care management teams can prioritize interventions where penalty reduction ROI is highest.
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Ohio Medicaid Managed Care Performance
Ohio Medicaid managed care operates through contracts with Molina, Anthem, Humana, CareSource, and UHC. Each plan's HEDIS performance requirements flow down to contracted hospitals. Vizier normalizes quality measure tracking across all Ohio Medicaid MCO contracts, surfacing care gaps at the attributed patient level before annual measurement periods close.
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SUD & Opioid Population Analytics
Ohio hospitals disproportionately manage patients with opioid use disorder who are high utilizers of both inpatient and emergency services. Vizier identifies SUD-associated readmission risk, models the impact of MAT bridge programs on 30-day readmission rates, and quantifies the financial return on investment of community health worker interventions for this population.
Ohio Health Systems

Organizations Like These Face Ohio's Analytics Challenges

Health systems like Cleveland Clinic, OhioHealth, ProMedica, Summa Health, Premier Health, University Hospitals Cleveland, and Kettering Health face quality performance pressure from commercial payers — Anthem BCBS, Medical Mutual of Ohio, UHC, and CareSource — that increasingly tie contract rates to HEDIS and MIPS scores. For academic systems competing for national reputation rankings, analytics gaps that suppress CMS quality scores have consequences beyond financial penalties: they affect US News rankings, referral patterns, and competitive positioning.

Cleveland Clinic (22 hospitals)
OhioHealth
ProMedica
Summa Health
University Hospitals Cleveland
Kettering Health
Regulatory Context

Ohio Compliance and Reporting Requirements

Ohio Medicaid managed care is administered by the Ohio Department of Medicaid (ODM) through contracts with five managed care organizations: Anthem, Molina Healthcare, Humana, CareSource (Ohio-based, nationally operating), and UnitedHealthcare. Ohio Medicaid launched a comprehensive managed care modernization initiative in 2022 that restructured MCO contracts, added new quality reporting requirements, and created specialized programs for children, complex needs adults, and duals. Each MCO submission deadline and quality measure specification creates compliance obligations for contracted hospitals.

Ohio also operates the Ohio Value-Based Payment program and participates extensively in CMS value-based care initiatives including the ACO REACH model and primary care transformation programs. The CMS Hospital Readmissions Reduction Program imposes penalties on Ohio hospitals at rates above national averages due to the state's elevated readmission baseline. Ohio hospitals submit quality data through the Ohio Hospital Association's Ohio Hospital Quality Trust program, which feeds both public reporting and MCO benchmarking.

Medicaid Program
Ohio Medicaid Managed Care (ODM)
Managed Care
Anthem, Molina, Humana, CareSource, UnitedHealthcare
Key Reporting
ODM quality metrics, HRRP penalties, HVBP, MIPS, ACO REACH
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