Patient-Centered Medical Home

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SoonerCare Choice New Design Starting January 2018

Since 2009 our Patient Centered Medical Home (PCMH) SoonerCare Choice delivery system has advanced along with health care delivery changes nationally. With further changes in national trends related to care coordination, quality, utilization and provider payments, we are enhancing our PCMH SoonerCare Choice by changing the tiers to base criteria, plus additional criteria that add additional money to your care coordination payments. We will keep the current FFS reimbursement and will be moving to value-based payments tied to achieving improvements in quality and population health.

We held four stakeholder meetings the week of January 16, 2017 to review our approach and to begin the discussion related to quality metrics. We will be having additional meetings on the quality metric selection in late February early March. Invitations will be sent to our Choice providers and posted on this website. This new section of the PCMH page will be updated to keep you informed and allow you to communicate your ideas to us as we move forward. Please review the PowerPoints below and if you have any questions, comments, ideas or concerns please email us at medhomecomments@okhca.org.

We held an additional four stakeholder meetings the week of March 3, 2017 to review and begin the discussion related to quality metrics. We will have a meeting in early April to discuss the case management fees and the dollars related to meeting the new quality metrics. Invitations will be sent to all Choice providers and posted on this website. This new section of the PCMH page will be updated to keep you informed and allow you to communicate your ideas to us as we move forward. Please review the PowerPoints below and if you have any questions, comments, ideas or concerns please email us at medhomecomments@okhca.org.

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

Patient-Centered Medical Home Archive