March 15, 2012
OHCA Contacts: Jo Kilgore - (405) 522-7474, Carter Kimble - (405) 522-7510
Public-Private Partnership Reaps SoonerCare Savings
Oklahoma City – The Oklahoma Health Care Authority has saved more than a million dollars by partnering with MedSolutions to administer the SoonerCare radiology management program.
OHCA contracted with MedSolutions in 2010 thru the competitive bid process to manage the approval process of prior authorization (PA) requests for all radiology scans such as CT and PET scans and MRIs. Since that time, some 58,000 requests have been processed with an 84 percent approval rate, usually within a two-day turnaround.
“Our goal for the program was to improve access for SoonerCare members while ensuring they received medically appropriate imaging,” said Ken Goodwin, OHCA Medical Authorization Services manager. “We’ve been able to reduce our prior authorization turnaround time while saving the program money. So we see that as a positive outcome.”
Through the program, PAs are reviewed via computer software. If the PA is not approved by the software, it is sent to a nurse for review. If upon review the nurse is unable to approve the PA, it is reviewed by a physician for final review and approval determination.
“The overarching goals of the program are to reduce the duplication of scans, lower radiation exposure and increase patient safety,” Goodwin noted. “However, if the scan is necessary, as has been the case with 84 percent of the requests, they are approved.”
During the first 12 months the program was in place, Nov. 1, 2010 through Nov. 1, 2011, it saved SoonerCare $1.15 million.