Melody Anthony, MS Director Provider Services

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Presentation transcript:

Melody Anthony, MS Director Provider Services SoonerCare Choice PCMH 3rd State Consortium to Advance Medical Homes in Medicaid and CHIP March 31, 2011 Melody Anthony, MS Director Provider Services

New SoonerCare Choice PCMH “Unbundled” to incorporate PCMH principles Monthly Case Mgmt / Care Coordination Fee Peer grouped by type of panel and capabilities of practice Office visit and service based component Fee for service Expanded Performance Component (SoonerExcel) Transitional Payments in 2009 for first year 2 years of planning resulted in our program moving to the PCMH model. We did this at the providers request 2 2 2

SoonerCare Choice PCMH PCP Network: Feb 2011 1,494 PCPs at 831 sites with 1,169,468 total member capacity 255 PCPs have been added to the network 42% Member capacity being utilized 454,112 members are enrolled statewide SoonerCare choice is 64% of total enrollment. Programs Total Enrollment = 720,000 3 3 3 3

SoonerCare Choice PCMH: PCP Tier Summary January 2009 Tier 1 = 445 Tier 2 = 223 Tier 3 = 31 Total = 699 February 2011 Tier 1 = 551 Tier 2 = 225 Tier 3 = 55 Total = 831 January 09 total = 699 February 2011 = 831 Our goal is to move all tier upward. Most of our new provider choice level 1 until they get a better understanding of our medical home concept June 2010 779 Payment Tier Code Count Tier 1 521 Tier 2 213 Tier 3 45 Total = 779 Tier count is determined by provider location 4 4 4 4

SoonerCare Choice by Calendar Year Does It Work? HEDIS Measures SoonerCare Choice by Calendar Year   2001 2002 2003 2004 2005 2006 2007 2008 2009 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) 32.60% 34.50% 43.50% 42.00% 43.70% 44.40% Children's Access to PCP (CAP) (at least one PCP visit) 12-24 months 88.10% 89.50% 90.80% 91.40% 91.60% 94.30% 94.10% 96.20% 7-11 yrs 76.70% 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 yrs 68.40% 68.80% 69.80% 71.60% 72.00% 74.90% 75.60% 78.40% 83.30% 45-64 yrs 80.30% 81.30% 81.80% 82.80% 84.20% 85.20% 86.80% 89.70% Significant increase from previous year Significant decrease from previous year It works we improved in 16 of 22 HEDIAS measures. These are the one with the greatest improvement 5

SFY 2009 CAHPS® Child Health Survey High satisfaction steady across six quality measures Statistically significant improvement in 2 areas Rating increased from 8.24 to 8.73 Overall rating of child’s health plan: Rate increased from 51.89% to 70.28% Always getting treatment quickly: 6

SFY 2010 CAHPS® Adult Health Survey Rising satisfaction with health care and customer service Statistically significant improvement in access to care Rate increased from 52.01% to 59.58% Always getting treatment quickly: 7

SoonerCare Choice PCMH: Member Inquiries Jan-Dec 2008 Jan-Dec 2009 Jan-Dec 2010 Members 407,408 438,276 440,842 Access to Care 7,833 1,322 509 Same Day / Next Day Access to Care 1,670 13 4 8

Changes through 2010 Reduced per capita cost Provider Profiles 2008 $24.95 2010 $22.53 Provider Profiles Statistically significant improvement in observed to expected ER visit ratio Over 6.7M paid out through SoonerExcel since inception of the PCMH model Average payment per provider $1,100.00 The reduction in cost was a pleasant surprise. The transition of the payment methodology was based on budget neutrality. This reduction in per capita cost is in preventive and office visit codes 9