May 16, 2013

OHCA Contacts: Jo Kilgore - (405) 522-7474, Carter Kimble - (405) 522-7510

The Oklahoma Health Care Authority’s SoonerCare Health Management Program has saved the state of Oklahoma $139.2 million since it began in February 2008, according to an evaluation by the California-based Pacific Health Policy Group.

Overall, the SoonerCare HMP has generated more than $6 in medical savings for every $1 in administrative expenditures.

The HMP program has been used as a model in states such as Arkansas, Texas, Connecticut and Nevada. It was developed after a 2006 Oklahoma legislative mandate was given to focus on SoonerCare members with chronic conditions, to reduce costs, and to increase the quality of care.

“What we saw when we started [in 2006] was that traditional disease management programs were not working and we knew that those methods could not work for us,” said Dr. Mike Herndon, medical director of the SoonerCare HMP.

“We decided to take a more innovative, holistic, and comprehensive approach that was based on Dr. Ed Wagner’s Chronic Care Model,” he added.

The OHCA’s HMP program emphasizes development of member self-management skills and provider adherence to evidence-based guidelines and best practices.

The program consists of two major components: nurse care management that focuses on high-risk patients and practice facilitation, which aims to assist providers in offering quality care for patients.

Some of the nurse care management outcomes presented in the report include a reduction in hospital admissions and emergency department utilization as well as improvement in quality of care measures. The report also revealed reduced risk scores and gaps in care, high member satisfaction scores, and cost decreases resulting from cost avoidance.

Eighty-eight practices that served approximately 115,000 SoonerCare members have participated in the practice facilitation arm of the program. There was a significant increase in compliance rates for chronic conditions across these practices in 2012.

Beginning on July 1, the SoonerCare HMP will shift the structure of service delivery. One of the key changes will be embedding nurses in health coaching roles in targeted primary care practices as opposed to the current combination of face to face and telephonic case management. The health coaches will be highly skilled in Motivational Interviewing, a counseling approach developed by Dr. William Miller and Dr. Stephen Rollnick that emphasizes a patient-centered, patient-driven approach to working with patients. Practice facilitation will remain an essential part of the program, focusing on strategies to improve the overall efficiency and quality of care provided by the practice.

The program is administered by Telligen, a nationally recognized population health management company. They were awarded the initial contract to implement the program in 2007, and were recently chosen as the vendor for the new program, starting July 1.

More information about SoonerCare and its programs can be found at www.okhca.org.

#30#