SoonerCare Choice

The Oklahoma Health Care Authority implemented a patient-centered medical home primary care delivery system on January 1, 2009. The model incorporates a managed care component with traditional fee-for-service and incentive payments. It is Oklahoma's intent to build on the successes already achieved in SoonerCare Choice to establish a patient-centered medical home for all SoonerCare Choice members.

In the SoonerCare Choice program every member has a primary care provider whose office is considered their medical home. Some members also have a provider that is part of a HAN and therefore have access to increased care coordination.

Goals: 

• Enhance patient choice and participation in health decisions; 
• Assure all members receive all necessary preventive and primary care; 
• Increase the provider network; 
• Reduce inappropriate emergency department visits and hospitalizations; 
• Realign payment incentives to improve cost effectiveness and quality; and 
• Promote the use of health information.

All PCMH providers are required to provide 24-hour/7-day coverage by a medical professional. In addition, OHCA requires Tier 3 PCMH providers to provide extended office hours for members who aren’t able to visit them during normal hours. OHCA pays PCMH providers a monthly care management fee for their effort, which increases with every tier level. PCMH providers are also incentivized by SoonerExcel payments that are paid to providers for offering increased care coordination support and decreasing member nonemergent ER utilization.