Patient-Centered Medical Home

PCMH Redesign Planned for October 2020

Incorporating ideas and suggestions collected during our Stakeholder input meetings during September and October 2019, OHCA is working to bring a new value-based enhanced design to the providers in the Patient Centered Medical Home program (SoonerCare Choice, SoonerCare Choice ITUs and Insure Oklahoma Individual Plan). The new design will include increased care coordination payments along with performance measures that have been recommended by providers in previous workgroups. Providers will receive payments based on what they bring to the program, particularly integration with behavioral health services and social determinations/substance use disorder screening and referral. The anticipated start date is October 2020, dependent on CMS approval.

You can download the PowerPoint Presentation here.

Medical Home Evaluation Forms 

On an annual basis, providers can request one assignment to a new level. OHCA will review the request and, if the reassignment is granted, the change will be effective on the following January 1. In order to have a level change effective January 1, of the following year, OHCA needs to receive your request by September 30, of the current year. 

•  Entry Level Application  
•  Advanced Level Application 
•  Optimal Level Application
  

Care Coordination Rates 10/1/18

PCP Tools and Resources

• Resources and Tools (Forms, Practice Guidelines)
• OHCA Care Management Department
• OHCA Health Management Program
• Health Access Network Defined
• Community Resources to Support the Medical Home Concept
• Quality Initiatives
• NASHP monitors state efforts to advance medical homes for Medicaid and CHIP participants.
• NASP Presentation (Powerpoint)
• MAC Presentation (Powerpoint)
• MMIS Presentation (Powerpoint)

Behavioral Health Screenings

Screening and brief intervention is an integral part of preventive health. Time is a critical factor for PCPs. Blended approaches to screening help a great deal in improving the efficiency of a comprehensive effort at prevention. The OHCA behavioral health and substance abuse screening tool can aid in this effort because it is an integrated approach.

• Patient Centered Medical Home Behavioral Health Screening

Reimbursement

• Change in Payment Structure
• Fee-For-Service Schedule
• Incentive Payments
• Transitional Payments
• SoonerCare Choice After-Hours

SoonerCare Choice Redesign Goals

• Guarantee the availability of a medical home with a primary care provider for all SoonerCare Choice members
• Enhance patient choice and participation in health decisions
• Assure all members receive all necessary preventive and primary care, including immunizations and health screenings
• Increase the provider network
• Reduce inappropriate Emergency Department visits and hospitalizations
• Realign payment incentives to improve cost effectiveness & quality
• Promote the use of health information systems

Patient-Centered Medical Home Archive