Patient-Centered Medical Home

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PCMH Redesign Planned for October 2020 – Requesting Stakeholder Input

Based on provider suggestions collected in 2016 and 2017, OHCA is now prepared to bring a new value-based enhanced design to the providers in the Patient Centered Medical Home program (SoonerCare Choice, SoonerCare Choice ITUs and Insure Oklahoma Individual Plan). The new design will include increased care coordination payments along with performance measures that have been recommended by providers in previous workgroups. Providers will receive payments based on what they bring to the program, particularly integration with behavioral health services and social determinations/substance use disorder screening and referral. The anticipated start date is October 2020, dependent on CMS approval.

This Stakeholders meeting will be held on September 17th at 9:30 AM. We will be providing additional details regarding the new design, answering questions and requesting your input.

You can attend in person at this location:

OHCA
Beavers Bend Conference Room
4345 N. Lincoln Blvd., OKC, OK 73015

Or to attend the meeting via webinar, please register here: https://okhca.zoom.us/webinar/register/WN_kwNSIP-jTmy1Se2vOYA_hg

An additional forum will be hosted in early October.

 

SoonerCare Choice PCMH Redesign Delayed

3/23/17 - Based on information presented at the OHCA board meeting today by CFO Carrie Evans, we will not be making any changes to our current SoonerCare Choice PCMH program. We will be looking to find a better way for new providers to be contracted as a SoonerCare Choice provider. We are keeping all the potential changes on file and when we know more about the budget we can decide next steps. At this time, if you are a SoonerCare Choice provider nothing will change for you in January 2018. Feel free to ask medical home related questions through the medhomecomments@okhca.org e-mail address.  If you would like support or education with other provider related issues, please email SoonerCareEducation@okhca.org.    

 

SoonerCare Choice

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 level. 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 level change effective January 1, of the following year, OHCA needs to receive your request by September 30, of the current year. 

Care Coordination Rates 10/1/18

    Entry Level
  Advanced Level
  Optimal Level
 Adult Only
   4.84    6.31    8.40
 Child and Adult
   4.18    5.46    7.25
 Child Only
   3.46    4.50    5.98


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