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

2. 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

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 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

6. 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

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