Patient-Centered Medical Home

SoonerCare Choice Redesign

At the request of our provider community and with collaboration with our Medical Advisory Task Force, the Oklahoma Health Care Authority implemented a patient-centered medical home primary care delivery system on January 1, 2009. This model incorporates a managed care component with traditional fee-for-service and incentive payments. It is our intent to build on the successes already achieved in SoonerCare Choice to establish a patient-centered medical home for all SoonerCare Choice members.

• Medical Advisory Task Force
• Medical Home Principles
• Medical Home Implementation Presentation
• Medical Home Fall Training Presentation
• SoonerCare’s Patient-Centered Medical Home: A Message to Community and Advocacy Groups (Video)

PCP Tools and Resources

• Resources and Tools (Forms, Practice Guidelines)
• OHCA Care Management Department
• OHCA Health Management Program 
• Health Access Network Defined
• Community Resources to Support the Medical Home Concept
• Quality Initiatives 
• NASHP monitors state efforts to advance medical homes for Medicaid and CHIP participants.
• NASP Presentation (Powerpoint)
• MAC Presentation (Powerpoint)
• MMIS Presentation (Powerpoint)

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.

• Patient Centered Medical Home Behavioral Health Screening 

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 November 15, of the current year. 

• Tier 1 Self Evaluation 
• Tier 2 Self Evaluation 
• Tier 3 Self Evaluation 

Reimbursement

• Change in Payment Structure 
• Fee-For-Service Schedule 
• Incentive Payments
• Transitional Payments 
• SoonerCare Choice After-Hours

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