Transcript MMIS Presentation (Powerpoint)

SoonerCare
Oklahoma’s PatientCentered Medical Home
August 3, 2011
Melody Anthony, MS
Director Provider Services
2004-2008
SoonerCare Choice
• Partially-capitated primary care case
management (PCCM) program
– Average PMPM payment $24
• Primary and preventive services
– Office visits to the PCP
– Child health screenings (EPSDT)
– Injections, immunizations
– Limited lab services
– Case management including referrals
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12 Physician-Member Medical
Advisory Task Force (MAT)
• At the request of providers the MAT
was created February 2007
• Members delegated by professional
state organizations including:
– Osteopathic Association
– Medical Association
– Academy of Family Physicians
– American Academy of Pediatrics,
Oklahoma Chapter
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MAT Priorities
Patient
Centered
Medical Home
$ Payment $
$ Reform $
Budget neutral
Preventive Focus
Incentives
Care
Coordination
and Health
Information
Exchange
Assure/Facilitate Access
Eliminate Auto-assign
Move Beyond Medical Model
Educate/Inform
Complex Health Needs
Telemedicine
Electronic Health
Records
Seamless Transitions
Patient-Centered Medical
Home Timeline
Feb 2007
MAT
created;
transition
design
March 2008
Outreach
campaign
Sept 2008
PCP
contract
Jan 2009
PCMH
launched
July 2010
1st Health
Access
Network
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SoonerCare Choice PCMH
PCP Network: April 2011
335
PCPs
have been
added to the
network
1,516 PCPs
at
831 sites
with
1,064,672
total member
capacity
448,103
members are
enrolled
statewide
40%
Member
capacity
being utilized
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SoonerCare Choice PCMH:
PCP Tier Summary
January 2009
April 2011
Tier 1 = 445
Tier 2 = 223
Tier 3 = 31
Total = 699
Tier 1 = 558
Tier 2 = 220
Tier 3 = 53
Total = 831
Tier count is determined by provider location
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Case Management/Care
Coordination Fee Summary
Type of
Practice
Tier 1
Tier 2
Tier 3
Children Only
$3.58
$ 4.65
$6.19
Children &
Adults
$4.33
$ 5.64
$7.50
Adults Only
$5.02
$6.53
$8.69
FQHCs/RHCs
$0.00
$0.00
$0.00
Tier 1 payments reflect additional payment for 24/7 voice
to voice & electronic communications from OHCA.
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Does It Work?
HEDIS Measures
SoonerCare Choice by Calendar Year
2001
Annual Dental Visit (Combined rate < 21 years) (ADV)
Breast Cancer Screening (BCS)
2002
2003
41.60% 46.60% 51.20%
2004
2005
2006
2007
2008
2009
53.60%
56.60%
56.30%
57.20% 59.70%
62.10%
N/A
N/A
29.80%
29.20%
31.90%
33.80%
35.10% 38.30%
43.00%
N/A
N/A
32.60%
34.50%
43.50%
42.00%
43.70% 44.40%
46.60%
12-24 months
88.10% 89.50% 90.80%
91.40%
91.60%
94.30%
94.10% 94.10%
96.20%
7-11 yrs
76.70% 79.00% 79.20%
77.30%
81.50%
80.40%
80.80% 82.70%
87.60%
20-44 yrs
68.40% 68.80% 69.80%
71.60%
72.00%
74.90%
75.60% 78.40%
83.30%
45-64 yrs
80.30% 81.50% 81.30%
81.80%
82.80%
84.20%
85.20% 86.80%
89.70%
Cervical Cancer Screening (CCS)
Children's Access to PCP (CAP) (at least one PCP visit)
Adult Access to Preventive/Amb Health Services (AAP)
Significant increase from previous year
Significant decrease from previous year
SFY 2009 CAHPS®
Child Health Survey
• High satisfaction steady across six
quality measures
• Statistically significant improvement in
2 areas
Overall rating of child’s health plan:
Rating increased from 8.24 to 8.73
Always getting treatment quickly:
Rate increased from 51.89% to 70.28%
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SFY 2010 CAHPS®
Adult Health Survey
• Rising satisfaction with health care
and customer service
• Statistically significant improvement
in access to care
Always getting treatment quickly:
Rate increased from 52.01% to 59.58%
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CMS 416 Report
• Effectiveness of the EPSDT
program
• 80% CMS screening benchmark
Child
Health
Exams
EPSDT
screening
rate
FFY 2008
FFY 2009
(Oct 07-Sept 08) (Oct 08- Sept 09)
73%
83%
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SoonerCare Choice PCMH:
Member Inquiries
Jan-Dec
2008
Members
Jan-Dec
2009
Jan-Dec
2010
407,408 438,276
440,842
Access to Care
7,833
1,322
509
Same Day / Next
Day Access to
Care
1,670
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Health Access Networks (HAN)
Integrated
health care
delivery
system
Organized to
restructure
and improve
the access,
quality and
continuity of
care
Organized to
enhance the
capabilities of
the network’s
affiliated PCPs
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HAN Components
Electronic Health Records
Access to Specialty Care
Telemedicine
Quality Improvement
Care coordination
for complex health needs
OU Sooner HAN
• 145 PCPs/Medical Homes at 8
sites serving 25,000 members
• All sites have EHR and
Telemedicine capabilities
• 520 members under care
management
Changes through 2010
• Reduced per capita cost
– 2008 $24.95
– 2010 $22.53
• Provider Profiles
– Statistically significant improvement of
over 10% in office/ER visit ratio
• Over $4M paid in SoonerExcel in
2010
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Questions or Comments
• Updates in global and banner messages,
provider letters, OHCA public website at
www.okhca.org/medical-home
• Contact OHCA
Rebecca Pasternik-Ikard
Deputy State Medicaid Director
405.522.7208
[email protected]
Melody Anthony
Provider Services Director
405.522.7360 / [email protected]
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