MM Curator summary
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
[MM Curator Summary]: We have winners in the Sooner State (Aetna, Humana, Centene). Not sure we have one that is exactly “provider-led” as was intended by the do-over effort, but hey. Potato, Potato.
Clipped from: https://oklahoma.gov/ohca/about/newsroom/2023/june/ohca-selects-organizations-to-assist-in-serving-oklahoma-medicaid.html
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.