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Leavitt Partners Report: Program Strengths and Areas for Continuing Improvement, June 27, 2013

Leavitt Partners Report: Program Strengths and Areas for Continuing Improvement, June 27, 2013

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Published by OK-SAFE, Inc.
OK-SAFE, Inc. - Title: Program Strengths and Areas for Continuing Improvement - Report by Leavitt Partners. Earlier this year the Oklahoma Health Care Authority (OHCA) hired Leavitt Partners to review the state's Medicaid system, (SoonerCare) and determine whether the OHCA was on the right track. The issue of an ACA compliant exchange is reported on as well.
OK-SAFE, Inc. - Title: Program Strengths and Areas for Continuing Improvement - Report by Leavitt Partners. Earlier this year the Oklahoma Health Care Authority (OHCA) hired Leavitt Partners to review the state's Medicaid system, (SoonerCare) and determine whether the OHCA was on the right track. The issue of an ACA compliant exchange is reported on as well.

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Published by: OK-SAFE, Inc. on Jul 11, 2013
Copyright:Attribution Non-commercial

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09/28/2013

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Program Strengths and Areasfor Continuing Improvement 
 
 An Evaluation of Oklahoma’s SoonerCare
 Acute Care Program
 
Prepared for the Oklahoma Health Care Authority
Final Report June 27, 2013
 
 1
Table of Contents
..................................................................................................................... 3Program Evaluation ..................................................................................................................................... 12Program Strengths ...................................................................................................................................... 12Feedback Mechanisms, Program Evaluation, and Suggestion Response ............................................... 12On-line Application and Enrollment Processes ....................................................................................... 13Professionalism/Expertise of Staff .......................................................................................................... 14Medical Home Model ............................................................................................................................. 14Provider Reimbursements ...................................................................................................................... 14Cost Control ............................................................................................................................................ 16Program Accuracy ................................................................................................................................... 19Insure Oklahoma ..................................................................................................................................... 19Areas for Continuing Improvement ............................................................................................................ 20OHCA Board and Advisory Committees .................................................................................................. 20HEDIS, CAHPS, ECHO ............................................................................................................................... 21Payment Performance Incentives ........................................................................................................... 25Shift of Behavioral Health Responsibilities ............................................................................................. 27Provider Capacity (Access) ...................................................................................................................... 29Evolving and Competing Delivery System Models .................................................................................. 30Conclusion ................................................................................................................................................... 32
 
 2
Introduction
In February 2013, the Oklahoma Health Care Authority (OHCA) contracted with Leavitt Partners toevaluate its current Medicaid program and to make recommendations on how to optimize access andquality of health care in the State. The outcomes produced from
this work will support the OHCA’
soverall mission statement, which is to
purchase state and federally funded health care in the mostefficient and comprehensive manner possible and to study and recommend strategies for optimizing theaccessibility and qua
lity of health care.”
1
 The contract includes two separate, but related, projects. The first project is an evaluation of the
existing acute care component of SoonerCare, the State’s Medicaid program
. As part of this evaluation,Leavitt Partners addressed whether SoonerCare is operating efficiently and effectively, what value theprogram provides to the State, the strengths and weaknesses of the program, and the program
sexisting opportunities and threats.For the second project, Leavitt Partners proposed a Medicaid demonstration proposal that outlinesrecommendations for
an “Oklahoma Plan,” which include
s state-based solutions to improve healthoutcomes, contain costs, and make efficient use of state resources in providing quality health care andreducing the number of uninsured families. The plan addresses and integrates all points of health caredelivery in the State, including Medicaid, the public health system, and the commercial insurancesystem. It focuses on market-based solutions and population health management.This report addresses the first component of the contract,
evaluating SoonerCare’s
acute care program.
Leavitt Partners’ recommended demonstration proposal is provided in a companion report, “Covering
the Low-
Income, Uninsured in Oklahoma: Recommendations for a Medicaid Demonstration Proposal.”
 
Environmental Scan
Leavitt Partners used a two-fold approach in its evaluation of the SoonerCare program. It first reviewed
the State’s current Medicaid program, gathering multiple perspectives of the program and its processes
in order to gain an understanding of the social, political, and financial environment in which the programoperates. As part of this review, Leavitt Partners performed an extensive environmental scan of SoonerCare by both reviewing publicly available documents and interviewing stakeholders to discuss theprogram and gain external perspectives on specific issues.During the interview process, Leavitt Partners met with:
 
The Planning Committee of the OHCA Board
 
One of the G
overnor’s
appointees to the OHCA Board
 
The Chairs of five of 
OHCA’s
Advisory Committees, including:
o
 
Child Health Advisory Task Force (CHATF)
o
 
Member Advisory Task Force (MATF)
o
 
Medical Advisory Committee (MAC)
o
 
Medical Advisory Task Force (MAT)
o
 
Perinatal Advisory Task Force (PATF)
1
 
“About Us,” Oklahoma Health Care Authority. Accessed June 17,
2013. http://www.okhca.org/about.aspx?id=32.

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