August 18, 2016
OHCA Contacts: Jo Kilgore - (405) 522-7474, Jennie Melendez - (405) 522-7404
Evaluation shows return doubled on OHCA health programs investment
OKLAHOMA CITY – A
recent report shows two programs targeting chronic diseases among SoonerCare
(Oklahoma Medicaid) members are returning about two-to-one savings for each
dollar invested by the Oklahoma Health Care Authority (OHCA).
OHCA received the
final report on the agency’s Health Management Program (HMP) and Chronic Care
Unit (CCU) for state fiscal year 2015 from independent evaluator Pacific Health
Policy Group (PHPG). It shows that both programs are having positive outcomes
related to quality of care, satisfaction, utilization and cost
The HMP was created as a result of the Oklahoma Medicaid
Reform Act of 2006 (HB2842). The legislature directed the OHCA to develop and
implement a management program for chronic diseases such as asthma, chronic
obstructive pulmonary disease (COPD), congestive heart failure and diabetes.
The program aims to address the health needs of chronically ill SoonerCare
members while reducing unnecessary medical expenditures at a time of
significant fiscal constraints.
In response, the OHCA developed the SoonerCare Health Management
Program (HMP), which offers health coaching by registered nurses to qualifying
members with one or more chronic conditions. The program also offers practice
facilitation and education to primary care providers who treat the chronically
The agency later developed
the CCU through which registered nurses provide case management over the phone
to participating SoonerCare members. The nurses assess members’ needs and
develop an action plan for improving self-management skills and health. They
to improve the health status, health literacy, behavioral health and
prescription drug utilization of members through care coordination,
self-management principles and behavior modification techniques.
CCU targets members with hemophilia, sickle cell
anemia, those receiving bariatric surgery, members with Hepatitis-C receiving
treatment and whose treating provider has referred them for case management,
and those identified through a health risk assessment.
are utilizing a team-based approach for these programs. We believe the first
key to success is identifying members who need these services. We then engage
the entire multidisciplinary team, including the member, in their education and
treatment,” said Marlene Asmussen, OHCA Director of Population
Care Management & Medical Authorization Services.
87 percent of members reported being very satisfied with
their health coaches.
The HMP as a whole during SFY14 and SFY15 has generated a net
savings (medical savings minus administrative costs) of $41.2 million.
The HMP generated a return on investment of 249 percent. Put
another way, the SoonerCare HMP generated nearly $2.50 in net medical savings
for every dollar in administrative expenditures.
91 percent of members reported being very satisfied with
their nurses when asked their overall satisfaction level.
The CCU realized a net savings (medical savings minus administrative
costs) of nearly $2.7 million in SFY15. Medical savings were approximately $4.1
The CCU achieved a positive return on investment of 195
percent. Put another way, the SoonerCare CCU generated nearly $2 in net
medical savings for every dollar in administrative expenditures.
reports are available at www.okhca.org/research.
Medicaid program, known as SoonerCare, is administered by the Oklahoma Health
Care Authority (OHCA). SoonerCare works to improve the health outcomes of
Oklahomans by ensuring medically necessary benefits and services are available
to our members. Qualifying Oklahomans include certain low-income children,
seniors, the disabled, those being treated for breast or cervical cancer and
those seeking family planning services. Insure Oklahoma assists qualifying
adults and small business employees in obtaining health care coverage for
themselves and their families. OHCA strives to educate and engage our current 788,116 members
regarding personal responsibilities for their health services utilization,
behaviors, and outcomes in partnership with a state-wide network of 45,802 providers. For
more information, visit www.okhca.org.