1. SoonerCare Oklahoma’s Patient- Centered Medical Home August 3, 2011 Melody Anthony, MS Director Provider Services

2. 2 2004-2008 SoonerCare Choice Partially-capitated primary care case management (PCCM) program –Average PMPM payment $24 Primary and preventive services –Office visits to the PCP –Child health screenings (EPSDT) –Injections, immunizations –Limited lab services –Case management including referrals

3. 3 12 Physician-Member Medical Advisory Task Force (MAT) At the request of providers the MAT was created February 2007 Members delegated by professional state organizations including: –Osteopathic Association –Medical Association –Academy of Family Physicians –American Academy of Pediatrics, Oklahoma Chapter

4. Assure/Facilitate Access Eliminate Auto-assign Move Beyond Medical Model Educate/Inform Budget neutral Preventive Focus Incentives Complex Health Needs Telemedicine Electronic Health Records Seamless Transitions MAT Priorities $ Payment $ $ Reform $ Care Coordination and Health Information Exchange Patient Centered Medical Home

5. 5 Patient-Centered Medical Home Timeline March 2008 Outreach campaign Feb 2007 MAT created; transition design Jan 2009 PCMH launched Sept 2008 PCP contract July 2010 1 st Health Access Network

6. 6 SoonerCare Choice PCMH PCP Network: April 2011 335 PCPs have been added to the network 1,516 PCPs at 831 sites with 1,064,672 total member capacity 448,103 members are enrolled statewide 40% Member capacity being utilized

7. 7 SoonerCare Choice PCMH: PCP Tier Summary January 2009 Tier 1 = 445 Tier 2 = 223 Tier 3 = 31 Total = 699 April 2011 Tier 1 = 558 Tier 2 = 220 Tier 3 = 53 Total = 831 Tier count is determined by provider location

8. 8 Type of Practice Tier 1Tier 2Tier 3 Children Only$3.58$ 4.65$6.19 Children & Adults $4.33$ 5.64$7.50 Adults Only$5.02$6.53$8.69 FQHCs/RHCs$0.00 Case Management/Care Coordination Fee Summary Tier 1 payments reflect additional payment for 24/7 voice to voice & electronic communications from OHCA.

9. Does It Work? HEDIS MeasuresSoonerCare Choice by Calendar Year 200120022003200420052006200720082009 Annual Dental Visit (Combined rate < 21 years) (ADV) 41.60%46.60%51.20%53.60%56.60%56.30%57.20%59.70%62.10% Breast Cancer Screening (BCS) N/A 29.80%29.20%31.90%33.80%35.10%38.30%43.00% Cervical Cancer Screening (CCS) N/A 32.60%34.50%43.50%42.00%43.70%44.40%46.60% Children's Access to PCP (CAP) (at least one PCP visit) 12-24 months88.10%89.50%90.80%91.40%91.60%94.30%94.10% 96.20% 7-11 yrs76.70%79.00%79.20%77.30%81.50%80.40%80.80%82.70%87.60% Adult Access to Preventive/Amb Health Services (AAP) 20-44 yrs68.40%68.80%69.80%71.60%72.00%74.90%75.60%78.40%83.30% 45-64 yrs80.30%81.50%81.30%81.80%82.80%84.20%85.20%86.80%89.70% Significant increase from previous year Significant decrease from previous year

10. 10 SFY 2009 CAHPS® Child Health Survey High satisfaction steady across six quality measures Statistically significant improvement in 2 areas Overall rating of child’s health plan: Rating increased from 8.24 to 8.73 Always getting treatment quickly: Rate increased from 51.89% to 70.28%

11. 11 SFY 2010 CAHPS® Adult Health Survey Rising satisfaction with health care and customer service Statistically significant improvement in access to care Always getting treatment quickly: Rate increased from 52.01% to 59.58%

12. 12 CMS 416 Report Effectiveness of the EPSDT program 80% CMS screening benchmark Child Health Exams FFY 2008 (Oct 07-Sept 08) FFY 2009 (Oct 08- Sept 09) EPSDT screening rate 73%83%

13. 13 SoonerCare Choice PCMH: Member Inquiries Jan-Dec 2008 Jan-Dec 2009 Jan-Dec 2010 Members407,408438,276440,842 Access to Care7,8331,322509 Same Day / Next Day Access to Care 1,670134

14. 14 Health Access Networks (HAN) Organized to enhance the capabilities of the network’s affiliated PCPs Integrated health care delivery system Organized to restructure and improve the access, quality and continuity of care

15. HAN Components Electronic Health Records Access to Specialty Care Telemedicine Quality Improvement Care coordination for complex health needs Care coordination for complex health needs

16. OU Sooner HAN 145 PCPs/Medical Homes at 8 sites serving 25,000 members All sites have EHR and Telemedicine capabilities 520 members under care management

17. 17 Changes through 2010 Reduced per capita cost –2008 $24.95 –2010 $22.53 Provider Profiles –Statistically significant improvement of over 10% in office/ER visit ratio Over $4M paid in SoonerExcel in 2010

18. 18 Questions or Comments Updates in global and banner messages, provider letters, OHCA public website at www.okhca.org/medical-home www.okhca.org/medical-home Contact OHCA Rebecca Pasternik-Ikard Deputy State Medicaid Director 405.522.7208 Becky.Pasternik-Ikard@okhca.orgrg Melody Anthony Provider Services Director 405.522.7360 / Melody.Anthony@okhca.orgMelody.Anthony@okhca.org