Oklahoma

Beginning in 2008, the Oklahoma Legislature passed Resolution 1058 in support of the patient-centered medical home (PCMH) and encouraged all health systems in Oklahoma to study and implement principles of the PCMH.  Chapter 1656 of the Session Laws created a Medical Home Task Force charged with studying PCMH implementation among commercial and public payers. Oklahoma Health Care Authority implemented a PCMH primary care delivery system in January 2009 for SoonerCare Choice members. This model incorporated a managed care component with traditional fee-for-service and incentive payments for medical homes.

Launched as one of the 17 Beacon Programs funded by the federal Office of the National Coordinator (ONC) for Health Information Technology, MyHealth Access Network - a non-profit coalition of more than 200 organizations in northeastern Oklahoma - used innovative health care technology and dissemination of impactful information to enhance the capacity of medical homes to coordinate care and improve patient health. MyHealth seeks to achieve per-capita cost savings through improved care delivery for under-served populations.  With an emphasis on access to specialty care and close regional disparities in health outcomes, MyHealth strives to show that diverse communities can achieve care that is high quality, affordable, efficient and results in healthier populations.

Oklahoma’s proposal for the State Demonstrations to Integrate Care for Dual Eligible Individuals includes multiple care coordination models for dual eligibles including:

  • Health Homes: A partnership between the State Mental Health Agency and the Oklahoma Department of Mental Health and Substance Abuse Services for management of members with mental health needs. A nurse care manager coordinates care with a team of providers, including community mental health center staff.
  • SoonerCare Silver: A care coordinator will serve as a “bridge” between Medicare and Medicaid programs and providers.  Interdisciplinary care teams will develop and implement a member-specific care plan.
  • Integrated Care Sites: Members receive care at a single site and are overseen by an interdisciplinary care team that includes the member, physician, nurse, and social worker. Providers receive blended capitation rate from Medicare and Medicaid.

 

CHIPRA: 
No
MAPCP: 
No
Dual Eligible: 
No
2703 Health Home: 
Yes
CPCi: 
Yes
SIM Awards: 
Yes
PCMH in QHP: 
No
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
3,722,400
Uninsured Population:
14%
Total Medicaid Spending FY 2013: 
$4.8 Billion 
Overweight/Obese Adults:
67.9%
Poor Mental Health among Adults: 
34.3%
Medicaid Expansion: 
No 

SB 563

SB 563 affirmed requirements for reporting of the percentage of health care expenses by each contracted entity on primary care services and that no later than the fourth year of a contract with the Medicaid program must devote at least 11% to primary care.

SB 1337

Requires Oklahoma state Medicaid managed care entitities to report on the percent of medical expenditures devoted to primary care.  Requires managed care entities to increase primary care expenditures to a minimum of 11% of medical expenditures within four years.

Oklahoma Health Home

Health Homes is an optional Medicaid State Plan benefit that provides an opportunity to build a person-centered system of care that achieves improved outcomes and better services and value for the Oklahoma SoonerCare program for individuals with complex needs.  The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) has partnered with OHCA to expand upon the patient-centered medical home model to provide coordinated primary and behavioral health integration.  

Resolution 1058

The legislation supported the patient-centered medical home (PCMH) and encouraged all health systems in Oklahoma to study and implement principles of the PCMH.

Chapter 1656, Session Laws of Oklahoma

The legislation created a Medical Home Task Force charged with studying PCMH implementation among commercial and public payers.

Paying docs to manage care shows promise—but the pay is about to drop

on Thu, 2015-01-29 00:00   lisabeth

The CMS Innovation Center’s massive Comprehensive Primary Care initiativeappeared to break even its first year, but there is concern that a planned reduction in its care-management fee this year could impede the fragile momentum it has built.

The program was launched in October 2012 with 502 participating practices supported by Medicare and 31 other insurance plans based in seven regional areas. 

Story Date: 
January 29, 2015
News Author: 
Andis Robeznieks
Source Link: 
Read More

CMS State Innovation Model (SIM) Design Award - Oklahoma

The State Innovation Model (SIM) grant was awarded to Oklahoma in December 2014 and is to begin in February 2015.  The goal of the Oklahoma SIM is to provide state-based solutions to Oklahoma’s healthcare challenges. Oklahoma’s plan aims to improve health, provide better care and reduce health expenditures for more than 1.2 million Oklahomans.

IMPaCTing Meaningful Improvements in Primary Care Practice

2014-05-05 12:00 to 13:30

Primary care extension programs improve the quality of primary care services by educating providers on new and innovative practices in areas such as preventive medicine, health promotion, and chronic disease management. Section 5405 of the Affordable Care Act authorizes the establishment of a national primary care extension program.

Register Here
Announcement Type: 
Webinar

INTEGRIS Health Medical Neighborhood Demonstration - Oklahoma

This award is part of the Health Care Innovation Awards program, a Department of Health and Human Services initiative investing up to $1 billion to test promising new approaches that aim to improve health care and lower program costs for recipients of Medicare, Medicaid and the Children's Health Insurance Program (CHIP).

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