Oklahoma SoonerCare - OK-SAFE

Oklahoma Oklahoma
SoonerCare: SoonerCare:
Access to Access to h
health care Mike Fogarty, CEO
Oklahoma Health Care Authority
www.okhca.org
Why OHCA was created
Cost Crisis –– Manage and Control
Cost Crisis 1993 Increasing Costs
g
Legislation Post‐
Study Panels
Medicaid Reform
Medicaid Reform
OHCA Created
1995 – First Generation Reform
1996
Managed Care model HMO yield savings first three years
• SoonerCare Plus SoonerCare Plus first three years (Urban) HMO
• SoonerCare Ch i (R l)
Choice (Rural) PCCM
www.okhca.org
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Source: Mathematica Evaluation of SoonerCare Choice , Full Report, page 86 http://www.okhca.org/research.aspx?id=10087&parts=7447
www.okhca.org
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Source: Mathematica Evaluation of SoonerCare Choice , Full Report, page 86 http://www.okhca.org/research.aspx?id=10087&parts=7447
www.okhca.org
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Legislative Mission
Crisis of the Uninsured
1997 – Second Generation Reform
Coverage Expansions – Higher Income Qualifications
• Kids
• Pregnant Women
• Aged, Blind, and Disabled
www.okhca.org
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Oklahoma Coverage Milestones, 1997 - 2010
735,000
712 237
712,237
710,000
685,000
660 000
660,000
634,640
635,000
610,000
611,722
606 923
606,923
585,000
574,193
560,000
535,000
531 191
531,191
510,000
515,672
485,000
480,581
460 000
460,000
January '03 January '04 January '05 January '06 January '07 January '08 January '09 January '10
Income Expansions
Nov 1997 Nov 2000
Eligibility
Change
Eligibility
Change
281,000
432,000
Jan 2005
April 2005
Oct 2005
Oklahoma
Cares
Sooner
Plan
TEFRA
Nov 2005
Insure
Oklahoma
ESI
Source: OHCA Business Objects report pulled 5.14.10; OHCA Annual Report SFY 2004-2006;
OHCA Fast Facts January 2007-2010; http://www.ohca.state.ok.us/research.aspx?id=46
Jan 2007
Insure
Oklahoma
IP
www.okhca.org
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Evolution of Medicaid M
dC
Managed Care
1998
HMO model HMO
model
continues to yield savings
1999
HMO rates begin increasing
2001
Turnover of HMO l
HMO plans
2003
HMO plans exit market
Limited market penetration
www.okhca.org
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Post HMO Managed Care
2004
Shift to focus on PCCM model statewide; S
SoonerCare Choice
C
Ch i
2004‐2010 ‐ Third Generation Reform
Service delivery system improvements
Service delivery system improvements •
Patient Centered Medical Home
•
Care Management
•
ER Utilization Program
•
Streamlined Newborn Enrollment
•
Online Enrollment
www.okhca.org
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Third Generation Reform
Patient Centered Medical Home
Sep. 2010‐
Sep
2010 The National The National
Association of State Health Policy highlights OHCA’s Patient‐
Centered Medical Home program. In the brief, the authors highlight the SoonerCare model as an option for other states, as they look to move toward a medical home model of payment.
Jul. 2011‐ The journal Health Affairs published a theme issue focused on new directions in systems innovation. Within the issue was a multi‐state
Within the issue was a multi
state study of medical home programs, of which Oklahoma was featured and touted as a promising national model
model. www.okhca.org
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Third Generation Reform
St
Streamlined Newborn Enrollment
li d N b
E
ll
t
Summer 2011‐ CMS opened an initiative for states to submit innovative programs p g
in how they are enrolling kids into Medicaid. Jan. 2011‐ Kaiser Commission on Medicaid d
d
and the Uninsured highlights e‐NB‐1 program as premiere way to optimize enrollment.
https://webinar.cms.hhs.
gov/chipreview/
www.okhca.org
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Third Generation Reform
O li E
Online Enrollment
ll
Feb. 2011‐ FamiliesUSA features OK’s online enrollment in their States in Focus section.
May 2011‐ During Quality Oklahoma Team Day, Online Enrollment is awarded the G
Governor’s award for ’
df
Motivating the Masses.
Sep. 2010‐ News of the new online enrollment system is distributed in a press release and is run in more than 20 papers from all over the
run in more than 20 papers from all over the state.
www.okhca.org
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Legislative Mission
Fill Uninsured Gap
2004‐2010 – Fourth Generation Reform
Private‐Public Partnership
p
• Insure Oklahoma – Employer Sponsored
• Insure Oklahoma – Individual Plan
• College students
• All Kids Act
www.okhca.org
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Fourth Generation Reform
I
Insure Oklahoma
Okl h
Dec. 2010‐ The City Sentinel publishes a
Sentinel publishes a feature story on IO with headline of “Since 2004, Insure Oklahoma has grown to helping 32,000 t h l i 32 000
uninsured state residents”. Sep. 2010‐ eCapitol News covers the legislation and discusses implications of extending the IO program t di th IO
to dependents of individuals on the program in an effort to curb uninsured children. Aug. 2011‐
Aug
2011 The Edmond Sun monthly The Edmond Sun monthly
business magazine starts a series of articles about options for small businesses to stay viable with health insurance as one of the key issues. Insure OK is featured as a good option for applicable small businesses. www.okhca.org
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Demonstration Waiver A
Accumulated Savings
l t dS i
Source: OHCA Federal Reporting, 1115(a) waiver
www.okhca.org
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Fourth Generation R f
Reform
Program
Enrollment July 2011
SoonerCare Choice
443,013
SoonerCare Traditional
243,228
SoonerPlan
36,916
Insure Oklahoma
32,431
Employer-Sponsored
p y
p
18,591
,
Individual Plan
13,840
Total
755,588
Source: OHCA Reporting and Statistics Unit. Data valid as of 8/30/2011
and subject to change
www.okhca.org
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Data Comparisons
OK
U.S.
High
State
Low
State
Percent Uninsured (2008-2009)
16%
17%
26%
TX
5%
MA
Percent of Pop Enrolled in Medicaid (2007)
20%
19%
29%
CA
10%
NV
Total Per Member Per Year Cost (2007)
$4595
$5163
$8796
RI
$3168
CA
Payment Accuracy Error Rates (PERM)
1.24%
8.98%
17.8%
1.24%
Medicaid to Medicare Fee Index (FFS)
(2008)
1.00
.72
1.43
WY
.37
NJ
Measure
Source: http://www.statehealthfacts.org/compare.jsp
https://www.cms.gov/PERM/Downloads/NAMPI_PERM_Update_8_2011.pdf
www.okhca.org
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Challenges ffor Generation Five
Challenges • Flexibility o Cost Sharing
o Benefit Package
Be efit Pa ka e
• Provider Access Issues o
o
o
o
Rural Oklahoma
Specialty Care
Primary Care
Graduate Medical Education Support
• Paying Responsible Rates • Program Integrity
o Protecting against waste, fraud and abuse
P t ti
i t
t f
d d b
www.okhca.org
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