Health Management Program FAQs

OHCA has established a contract with Telligen, the largest quality improvement organization in the country. Telligen's experience operating similar commercial programs in other states, along with their financial stability and quality improvement initiatives, ensures a successful Health Management Program that will benefit Oklahoma.

SoonerCare Choice members:

•  with or at risk for developing chronic disease(s),
•  at high risk for adverse outcomes, and
•  who have an increased likelihood of experiencing a health care crisis.

• In-person and telephonic health coaching by a registered nurse at participating providers’ offices;
• Educational materials and support regarding their health condition;
• Behavioral health screening and access to behavioral health resources; and
• Help with locating community resources.

The opportunity to be involved in a quality improvement initiative which offers CME credits, peer-to-peer collaboration and access to evidence-based guideline educational resources.

How it works:

1. PCPs receive an introductory letter announcing the program.

    2. Selected providers will be offered the opportunity to have a health coach embedded in their practice. The health coach will work with SoonerCare Choice members who have chronic conditions.

        A health coach is a registered nurse who specializes in motivational interviewing techniques to help those with chronic diseases. For more information, visit our Health Coaching page.

A practice facilitator acts as a free practice management consultant.

What is the purpose of practice facilitation? 

To assist the primary care practice with quality improvement initiatives that enhance quality of care; enhance proactive, preventive disease management; andenhance efficiencies in the office.

The amount of time practice facilitators are in the practice varies, depending on the level of services the practice receives. This may range from brief periods of academic detailing to the full practice facilitation services occurring over an extended duration.

The quality improvement initiatives and tasks are tailored to each individual practices’ environment and needs, but generally practice facilitators:

• Help prepare practice for receiving health coaching services;
• Observe and analyze office processes and flow; 
• Interview staff for points of frustration;
• Conduct clinic self-assessment;
• Abstract data from charts of chronic disease patients to look for gaps in care;
• Meet with provider and key staff to determine goals and action plans;
• Facilitate system redesigns to close gaps and meet goals;
• Keep providers updated and receive direction from providers periodically;
• Assist with implementation of CareMeasures web-based disease registry;
• Teach quality improvement and process improvement to staff;
• Help practice develop a team approach to care; and
• Follow up with practice after they leave to make sure systems are still working and address any problems.