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Oklahoma’s medical home model

Oklahoma’s medical home model. A Look At January 2009 to Present. Oklahomans are counting on us…. What Changed. Monthly payment Care Coordination FFS Incentive (also Transition for 1 st year) Care Coordination Based on date paid; no adjustments Elimination of Default Autoassignment

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Oklahoma’s medical home model

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  1. Oklahoma’smedical home model A Look At January 2009 to Present Oklahomans are counting on us….

  2. What Changed • Monthly payment • Care Coordination • FFS • Incentive (also Transition for 1st year) • Care Coordination • Based on date paid; no adjustments • Elimination of Default Autoassignment • Ability to change PCPs within the month

  3. What Changed, con’t • Group contracts must designate a medical director • OB/GYN providers can not be PCP • Elimination of Panel Hold • system stops enrollment at 95% capacity • Provider who sees children • MUST participate in VFC • MUST report in OSIIS • Coverage of new codes

  4. Program Enhancements • New Choice PCPs recruited • 70 new providers • Coverage of New codes for PCPs • Behavioral Health screening form (99408 and 99409) • After Hours codes (99050 and 99051) • Notification of inpatient admission and discharge’s from acute facilities • OHCA notification to member’s PCP • real time information for Oklahoma Cares program • data integrated in the Health Management Program

  5. How We’re Doing • Transition Payments • Only 18% still receiving transition payments • 50% fully transitioned to fee for service by March • 478 providers received over $6.8 m • Incentive Payments • 93% received an incentive payment • Average payment for the last quarter $1,448.47 • Total YTD 708 provider received over 1.5M • Utilization of New Codes • After hours 64 providers • BH Screening 7 providers

  6. What We Have Learned • Medical Home Tiers • 486 Tier 1 • 255 Tier 2 • 32 Tier 3 • 127 PCP locations have after hours available • 280 PCP locations have some form of electronic record • Over 200 PCP locations have 24/7 voice to voice

  7. Next Steps • PCP alignment process for Choice members who are not enrolled with a medical home • Develop and educate members on their responsibilities • Add custody kids to Choice Medical Home • Developing process for “No Shows” • Self evaluation forms updated for January 2010 • On line enrollment scheduled for Fall 2009

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