March 5, 2014

OHCA Contacts: Jo Kilgore - (405) 522-7474, Jennie Melendez - (405) 522-7404

Independent assessment shows aggregate savings of nearly $182 million over a five-year period. Program also sees measurable gains in improved health outcomes among program participants. 

A proactive approach in disease management is paying off in big ways at the Oklahoma Health Care Authority (OHCA). A recent evaluation of the agency’s SoonerCare (Oklahoma Medicaid) Health Management Program (HMP) shows a return on investment (ROI) of 562 percent.* This equates to more than six dollars in medical savings for every dollar in administrative expenditures. The analysis was conducted by Pacific Health Policy Group (PHPG), an independent evaluator.

“OHCA is again proud of the continued success of the SoonerCare Health Management Program (HMP) as evidenced by the latest evaluation report,” said OHCA’s Health Care Management Medical Director, Dr. Mike Herndon. “It is very gratifying to know that all the hard work is truly paying huge dividends.”

Treatment of chronic disease accounts for more than 75 percent of total U.S. health care spending** and places a significant burden on state Medicaid budgets. The SoonerCare HMP was developed in response to the Oklahoma Medicaid Reform Act of 2006 (HB2842), which mandated the OHCA to create and operate a management program to help improve the health of chronically ill SoonerCare (Oklahoma Medicaid) members while reducing unnecessary medical expenditures. Participants in the HMP suffer from chronic diseases such as asthma, congestive heart failure (CHF), and diabetes.

The “first generation” of the SoonerCare HMP launched in 2008 and consisted of two major components: nurse care management and practice facilitation/provider education. Telligen, a national quality improvement and medical management firm, was selected to administer the program under OHCA’s oversight. Telligen staff members provided nurse care management to SoonerCare HMP participants and free practice facilitation to OHCA-designated primary care providers.

PHPG evaluated the SoonerCare HMP’s fifth year of operations, state fiscal year (FY) 2013, in regard to:

• Structure and processes necessary for achieving program objectives
• Participant satisfaction (both members and physicians)
• Improved quality of care
• Demonstrated cost effectiveness

The HMP ranked high in participant satisfaction. Ninety-eight percent of nurse care management participants surveyed were pleased with their experience, with an overwhelming 88 percent reporting they were “very satisfied.” In addition, large percentages of active participants enrolled six months or longer reported adopting healthier lifestyles.

Ninety-one percent of facilitation providers say they would recommend the program to a colleague.  Survey respondents also credited the program with improving their adherence to clinical guidelines.

To examine quality of care, SoonerCare HMP participants were measured against a “comparison group” of SoonerCare members found eligible for, but not enrolled in the HMP. The participant compliance rate exceeded the comparison group rate for 16 of 21 diagnosis-specific measures (76 percent). The difference was statistically significant for 11 of the 16, suggesting that the program is having a positive effect on quality of care. The most impressive results, relative to the comparison group, were observed for participants with chronic obstructive pulmonary disease (COPD), CHF, diabetes and hypertension.

“Saving the state $182 million dollars over five-and-a-half years is wonderful, but I think we’re just as proud of the improvements in the quality of care also shown in this report,” said Herndon. “It’s nice to go back to the legislature, carrying this evaluation report, and say, ‘we did what you asked and here’s the result.’”

The complete PHPG evaluation can be found on the OHCA website at www.okhca.org/studies. 

FY 2013 marked the fifth and final year of the SoonerCare HMP’s first generation. As the program moves forward, the OHCA will work to generate additional savings in the form of avoided hospital days, emergency room visits and other chronic care service costs.
________________________________________

About Pacific Health Policy Group
PHPG is a national consulting firm specializing in the design and implementation of innovative health care initiatives for government-sponsored/funded programs, including Medicaid. 

*The SoonerCare HMP’s ROI can be calculated by comparing administrative expenditures to net medical savings across the program’s two components – nurse care management and practice facilitation.
**Centers for Disease Control 

#30#