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.

Our first Stakeholders webinar and in-person meeting was held on September 17th at 9:30 AM.  Additional stakeholders meeting are scheduled for October 22nd in Tulsa and October 23rd in Weatherford and Oklahoma City.  There is also an option to attend via webinar on October 23rd.  We will be providing additional details regarding the new design, answering questions and requesting your input. You can download the PowerPoint Presentation here.

Please register using the links below: 

Tulsa


Weatherford

Oklahoma City

 

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