Oklahoma medical home program exceeds goal of budget neutrality

Sixty percent of the 900,000 Oklahomans who were provided healthcare in fiscal year 2010 by the Oklahoma Health Care Authority received care from the SoonerCare Choice program, which transitioned to a Patient Centered Medical Home (PCMH) model in January 2009.

Becky Pasternik-Ikard, RN, chief operating officer of the Okahoma Health Care Authority, says that the program has resulted in almost 100% elimination of same day/next day medical access issues. "We have also seen a reduction in the calls to the after-hours patient advice line," she says.

Participants no longer have to wait 15 days when switching to a new primary care physician (PCP), she adds, and are able to see another PCP-level provider without switching from their current PCP.

"In addition, the elimination of the auto-assignment methodology has been applauded by our provider community," says Ms. Pasternik-Ikard. "Enrollment into SoonerCare Choice entails the affirmative selection of a PCP medical home."

The PCMH fosters a team approach to healthcare delivery, says Ms. Pasternik-Ikard, by engaging the patient, family, and medical staff. A care coordination fee is based on a tiered PCP classification system with a fee-for-service and incentive payment structure, she explains, all within the same budget parameters as the previous model.

The transition from the former SoonerCare Choice Primary Care Case Management Program, which operated statewide during 2004 to 2009, resulted in the reduction in the per capita expenditure for primary and preventive care services from $24.59 in 2008 to $22.53 for 2010, reports Ms. Pasternik-Ikard. "This exceeded our goal of budget neutrality," she says.

The PCMH program is viewed as the first layer in a platform to improve care to enrollees, according to Ms. Pasternik-Ikard. "We are now exploring the potential of medical homes to expand to health homes and the improved integration of physical and behavioral health," she says.

Contact Ms. Pasternik-Ikard at (405) 522-7208 or Becky.Pasternik-Ikard@okhca.org.