Patient-Centered Medical Home
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 email@example.com.
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 firstname.lastname@example.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
| Adult Only
| Child and Adult
| Child Only
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.
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