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

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

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

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

How We’re Doing Transition Payments Incentive 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

What We Have Learned Medical Home Tiers 486 Tier 1 255 Tier 2 127 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

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