Business Leadership to Build a Better Ohio

Governance & Fiscal Policy


State Fiscal Policy


With Ohio facing an projected $8 billion budget deficit in 2010, the BRT convened a CEO-led task force, with support from McKinsey & Company, that undertook an overarching independent review of the state budget - developing a state budget fact base, benchmarking Ohio against other states, conducting thoughtful analysis - to identify a menu of options for eliminating the gap. The analysis covered areas ranging from Medicaid, K-12 education, higher education, prisons/corrections, and state benefits and pensions. Potential savings levers were evaluated through the lens of what is best for the state of Ohio rather than what is best for this stakeholder group or that group.


The BRT's state budget analysis was shared with Governor-elect John Kasich in December 2010 and helped to inform the Administration's budget policy proposals that eliminated the $8 billion budget gap without the need to address revenues. The impact of the BRT's collaboration with state leaders on budget issues is most compellingly evident in the policy reforms being advanced and implemented by the Governor's Office of Health Transformation - reforms that are helping to rein in Medicaid costs while providing better care and improved health outcomes.


The BRT continues to work closely with the Governor and leaders in the Ohio Senate and Ohio House of Representatives to keep Ohio on the path back to prosperity through effective management principles and progressive, responsible fiscal policy.

Medicaid Reform


THE BRT's work on Medicaid reform is an excellent example of how the organization forges effective public-private collaborations in which business leaders develop the definitive fact base and provide the in-depth analysis, which government then uses to help shape and implement the required systemic changes.


The BRT's contribution to Medicaid reform efforts in Ohio began in 2007 when it commissioned McKinsey & Company to conduct a comprehensive diagnostic and benchmarking of Ohio health systems. The McKinsey report determined among other things that Medicaid spending, the second-largest components of the state budget, was rising at an unsustainable rate - more than twice the rate of growth for Gross State Product - and imposing a significant burden on the state's overall economy. Medicaid reform consequently was identified as one of the 18 underlying priorities in the BRT's "roadmap" for healthcare system improvement for Ohio.


The BRT supplemented this initial work on Medicaid with additional in-depth analysis of Ohio's Medicaid system in 2010. This work was conducted as part of the Roundtable's overarching review of the state budget (see the BRT's state budget fact case and state budget analysis) with the objective of identifying options for eliminating Ohio's looming $8 billion budget gap. This analysis identified four major challenges to address in improving Ohio's Medicaid system:


  • Addressing operational efficiencies
  • High use of expensive and/or unnecessary treatments and hospitalization
  • Poorly coordinated care of the aged and disabled population
  • High cost and above-average use of institutional care, particularly nursing homes


BRT recommendations for improving the cost-effectiveness of Ohio's Medicaid system have been embraced by Governor Kasich's Office of Health Transformation, which is implementing many of the recommendations and helping to move Ohio forward. The BRT has transitioned into an advocacy role where Medicaid reform is concerned, vigorously championing the Administration's efforts to implement a modernized healthcare delivery model that reins in Medicaid spending while providing better care and improved health outcomes. For example, see BRT President Richard Stoff's op-ed columns in The Columbus Dispatch and The (Cleveland) Plain Dealer, as well as his You Tube video commentary on the Kasich Administration's efforts to craft and implement a modernized healthcare delivery model that will rein in Medicaid spending while providing even better care and better outcomes.



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