A recent report shows two programs targeting chronic diseases among SoonerCare (Oklahoma Medicaid) members are returning about two-to-one savings for each dollar invested by the Oklahoma Health Care Authority).

 

OHCA received the final report on the agency's Health Management Program and Chronic Care Unit for state fiscal year 2015 from independent evaluator Pacific Health Policy Group. It shows that both programs are having positive outcomes related to quality of care, satisfaction, utilization and cost effectiveness.

 

The HMP was created as a result of the Oklahoma Medicaid Reform Act of 2006 (HB2842). The legislature directed the OHCA to develop and implement a management program for chronic diseases such as asthma, chronic obstructive pulmonary disease, congestive heart failure and

diabetes. The program aims to address the health needs of chronically ill SoonerCare members while reducing unnecessary medical expenditures at a time of significant fiscal constraints.

 

In response, the OHCA developed the SoonerCare Health Management Program, which offers health coaching by registered nurses to qualifying members with one or more chronic conditions. The program also offers practice facilitation and education to primary care providers who treat

the chronically ill.

 

The agency later developed the CCU through which registered nurses provide case management over the phone to participating SoonerCare members. The nurses assess members' needs and develop an action plan for improving self-management skills and health. They also work to improve the health status, health literacy, behavioral health and prescription drug utilization of members through care coordination, self-management principles and behavior modification techniques.

 

The CCU targets members with hemophilia, sickle cell anemia, those receiving bariatric surgery, members with Hepatitis-C receiving treatment and whose treating provider has referred them for case management, and those identified through a health risk assessment.

 

"We are utilizing a team-based approach for these programs. We believe the first key to success is identifying members who need these services. We then engage the entire multidisciplinary team, including the member, in their education and treatment," said Marlene Asmussen, OHCA Director of

Population Care Management & Medical Authorization Services.

 

Key findings include:

 87 percent of members reported being very satisfied with their health

coaches.

 The HMP as a whole during SFY14 and SFY15 has generated a net savings (medical savings minus administrative costs) of $41.2 million. The HMP generated a return on investment of 249 percent. Put another way, the SoonerCare HMP generated nearly $2.50 in net medical savings for

every dollar in administrative expenditures.

CCU:

91 percent of members reported being very satisfied with their nurses when asked their overall satisfaction level.

The  CCU realized a net savings (medical savings minus administrative costs) of nearly $2.7 million in SFY15. Medical savings were approximately $4.1 million.

The CCU achieved a positive return on investment of 195 percent.  Put another way, the SoonerCare CCU generated nearly $2 in net medical savings for every dollar in administrative expenditures.

 

The complete reports are available at www.okhca.org/research.