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Emily Long, Public Affairs Coordinator
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OHCA Selects Organizations to Assist in Serving Oklahoma Medicaid
Oklahoma City, OK – The Oklahoma Health Care Authority has selected three qualified and experienced contracted entities to assist in executing OHCA's comprehensive health care model, SoonerSelect, for certain SoonerCare members.
The selected contracted entities serving the medical plans are Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma and Oklahoma Complete Health, a subsidiary of Centene Corporation. The selected contracted entity serving the children's specialty program is Oklahoma Complete Health. Each of the contracted entities meets the statutory requirements of a provider-led entity and must also contract with local Oklahoma provider organizations.
"By moving away from a fee-for-service model toward this new delivery system, we can increase the effectiveness of SoonerCare while achieving better health outcomes," said Kevin Corbett, OHCA CEO. "SoonerSelect places a strong emphasis on quality of service and health outcomes while maintaining fiscal responsibility for Oklahoma taxpayers."
SoonerSelect will allow OHCA to incentivize health outcomes while maintaining oversight and authority over Oklahoma's Medicaid program and the program funding. OHCA is committed to improving the health and lives of SoonerCare members and will hold its SoonerSelect partners to the highest standards through stringent accountability measures.
By contracting with provider-led entities, OHCA will strengthen the voice of local providers and leverage their expertise and familiarity with Oklahoma communities in delivering health care services to SoonerCare members.
This transition in health care delivery will allow OHCA to achieve the following payment and delivery system reform goals:
- Improve health outcomes for Oklahomans
- Move toward value-based payment
- Improve SoonerCare member satisfaction
- Contain costs by investing in preventive and primary care
- Increase cost predictability to the State
"The selected organizations are the best at what they do and their established partnerships with Oklahoma providers is vital to the success of the program," said State Medicaid Director Traylor Rains. "I am confident in their ability to assist us in providing high-quality services to our SoonerCare members."
Oklahoma joins 40 other states in engaging third-party organizations to administer certain Medicaid benefits. States have reported positive outcomes by investing in primary care, preventive services and effective quality improvement strategies, such as addressing maternal health outcomes, obesity and smoking rates, and reduced emergency room utilization.
It is common for these contracted organizations to be heavily invested in infrastructure, including technology, staffing, and research on best practices to coordinate care for members. The selected organizations must have an Oklahoma presence, including key staff and call center operations.
The contracts were competitively bid and were selected after a technical evaluation and oral presentations. The contracts are for an initial term through June 30, 2025 with five renewal options. OHCA staff will spend the next several months working with the contracted entities to ensure a smooth transition for SoonerCare members and will continue to oversee the plans to ensure a high level of care for members.
Subject to approval by the Centers for Medicare and Medicaid Services, OHCA expects to launch the medical and children's specialty plans in April 2024. The SoonerSelect dental plans which were previously announced are expected to launch in February 2024.
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About Aetna Better Health of Oklahoma
Aetna Medicaid Administrators LLC (Aetna Medicaid), a CVS Health company, has over 30 years of experience managing the care of under-resourced populations, using innovative approaches and a local presence in each market to achieve both successful health care results and effective cost outcomes. Aetna Medicaid has expertise serving high-need Medicaid members, including those who are dually eligible for Medicaid and Medicare. Currently, Aetna Medicaid owns and/or administers Medicaid managed health care plans under the names of Aetna Better Health and other affiliate names. Together, these plans serve members in 16 states, including Arizona, California, Florida, Illinois, Kansas, Kentucky, Louisiana, Maryland, Michigan, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia and West Virginia. For more information, see www.aetnabetterhealth.com.
About Humana Healthy Horizons
Humana Inc. is committed to helping Humana’s millions of medical and specialty members achieve their best health. Humana’s successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Humana’s efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
To accomplish that, Humana supports physicians and other health care professionals as they work to deliver the right care in the right place for their patients, our members. Humana’s range of clinical capabilities, resources and tools – such as in-home care, behavioral health, pharmacy services, data analytics and wellness solutions – combine to produce a simplified experience that makes health care easier to navigate and more effective. More information regarding Humana is available at humana.com.
About Oklahoma Complete Health
Oklahoma Complete Health is a Care Management Organization that serves the needs of Oklahomans through a range of health insurance solutions. Oklahoma Complete Health serves our communities by focusing on under-insured and uninsured individuals through its federal insurance marketplace plan (Ambetter) and its Medicare Advantage Plan (Wellcare). Oklahoma Complete Health is a wholly owned subsidiary of Centene Corporation, a leading healthcare enterprise. For more information visit www.oklahomacompletehealth.com.
Centene Corporation, a Fortune 500 company, is a leading healthcare enterprise that is committed to helping people live healthier lives. The Company takes a local approach – with local brands and local teams – to provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene offers affordable and high-quality products to nearly 1 in 15 individuals across the nation, including Medicaid and Medicare members (including Medicare Prescription Drug Plans) as well as individuals and families served by the Health Insurance Marketplace and the TRICARE program. The Company also contracts with other healthcare and commercial organizations to provide a variety of specialty services focused on treating the whole person. Centene focuses on long-term growth and value creation as well as the development of its people, systems, and capabilities so that it can better serve its members, providers, local communities, and government partners.
Centene uses its investor relations website to publish important information about the Company, including information that may be deemed material to investors. Financial and other information about Centene is routinely posted and is accessible on Centene's investor relations website, https://investors.centene.com.
