Patient-Centered Medical Home

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SoonerCare Choice Redesign

At the request of our provider community and with collaboration with our Medical Advisory Task Force, the Oklahoma Health Care Authority implemented a patient-centered medical home primary care delivery system on January 1, 2009. This model incorporates a managed care component with traditional fee-for-service and incentive payments. It is our intent to build on the successes already achieved in SoonerCare Choice to establish a patient-centered medical home for all SoonerCare Choice members.

Medical Home Evaluation Forms 

On an annual basis providers can request one assignment to a new tier. OHCA will review the request and, if the reassignment is granted, the change will be effective on the following January 1. In order to have a tier change effective January 1, of the following year, OHCA needs to receive your request by October 31, of the current year. 

Care Coordination Rates 2/1/16

     Tier 1
  Tier 2
  Tier 3
 Adult Only
   4.70    6.13    8.15
 Child and Adult
   4.06    5.30    7.04
 Child Only
   3.36    4.36    5.81


PCP Tools and Resources

Behavioral Health Screenings

Screening and brief intervention is an integral part of preventive health. Time is a critical factor for PCPs. Blended approaches to screening help a great deal in improving the efficiency of a comprehensive effort at prevention. The OHCA behavioral health and substance abuse screening tool can aid in this effort because it is an integrated approach.

Reimbursement

SoonerCare Choice Redesign Goals

  • Guarantee the availability of a medical home with a primary care provider for all SoonerCare Choice members
  • Enhance patient choice and participation in health decisions
  • Assure all members receive all necessary preventive and primary care, including immunizations and health screenings
  • Increase the provider network
  • Reduce inappropriate Emergency Department visits and hospitalizations
  • Realign payment incentives to improve cost effectiveness & quality
  • Promote the use of health information systems