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Chronic Condition Executive Summaries

The executive summaries provide the Oklahoma Health Care Authority, associated stakeholders and the public, information and data about the prevalence of select chronic conditions and expenditures for members enrolled in the SoonerCare program. Data for the reports are extracted from the Medicaid Management Information System, a large repository of health care service claims, enrollment information and costs for services provided to enrolled members. Claims data from the MMIS allows OHCA to assess the care delivered to members across the spectrum of the health care system.

In each executive summary, the term “members” refers to individuals enrolled in the SoonerCare program. SoonerCare improves the health of qualified Oklahomans by ensuring that medically necessary benefits and services are available. Qualifying Oklahomans include certain low-income children, seniors, individuals who are disabled, those being treated for breast or cervical cancer and those seeking family planning services. 

The data provided in these reports may be conservative due to use of claims data. Members are only identified as having the select chronic condition if they sought care and had at least two or more paid claims that included a diagnosis code for the select chronic condition. Click here for the full list of ICD-10 diagnosis codes used for each chronic condition report

Definition of Terms

Members who are 19 years old or older at the end of the state fiscal year.
Child Members who are 18 years old or younger at the end of the state fiscal year.
Dual Eligible Members who are enrolled in both Medicaid and Medicare. Crossover claims, those transferred from the Medicare system to the state Medicaid system, are used to identify dual eligible members. If a member had a paid crossover claim in the state fiscal year, the member is identified as dual eligible.
Prevalence Rate The number of members with two or more paid claims indicating the select chronic condition in the SoonerCare enrollment, divided by the total number of members enrolled in SoonerCare. Prevalence rate indicates the number of cases of the condition present in the SoonerCare population during the state fiscal year of reporting.
Insure Oklahoma Implemented under the federal Health Insurance Flexibility and Accountability waiver. Provides health coverage to eligible adults and their dependents who are either uninsured or at risk of losing their coverage due to high premium costs. The state share of Insure Oklahoma costs comes from the state’s tobacco tax revenues. Insure Oklahoma has two plans – Employer-Sponsored Insurance and the Individual Plan.
SoonerCare Choice A patient-centered medical home program in which each member has a medical home, where a primary care provider organizes the health care services.
SoonerCare Traditional A comprehensive health care plan for members who do not qualify for SoonerCare Choice. SoonerCare Traditional provides coverage for members who are institutionalized, in state or tribal custody, covered under a health maintenance organization or enrolled under one of the home and community-based services waivers.
SoonerPlan A benefit plan that covers limited services related to family planning. SoonerPlan provides family planning services and contraceptive products to women and men 19 years old and older who do not choose or typically qualify for full SoonerCare benefits.
State Fiscal Year A 12-month period starting on July 1 and ending on June 30.