Oklahoma Awards Managed Care Contracts to Three Provider-Led Entities in Partnership with Three National MCOs
Oklahoma Health Care Authority (OHCA) has selected three contracted entities to assist in executing their Medicaid managed care program, SoonerSelect, for certain SoonerCare members
THE VBP Blog
June 22, 2023 – The Oklahoma Health Care Authority (OHCA) recently selected three qualified and experienced contracted entities to serve Medicaid members via SoonerSelect, the Medicaid managed care program in Oklahoma. 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.
This is Oklahoma’s second attempt at implementing Medicaid managed care and comes just two years after the first attempt was halted. What’s unique is that the three experienced MCOs, have partnered with provider-led entities to provide managed care services in the state. By having provider-led entities with specialized experience managing populations with complex needs, Oklahomans utilizing SoonerCare can get the best care and see better health outcomes.
In this blog, we focus on the innovative approach and the evolving dynamics of SoonerCare’s journey, in the light of the recent developments in managed care, and the newly minted contracts set to herald a new chapter in its story.
Medicaid Managed Care – Oklahoma’s Tumultuous History
The journey of Oklahoma towards a managed care model to revamp the delivery of healthcare services has not been without conflict. The state originally issued a Request for Proposal (RFP) for SoonerSelect Managed Care Organizations (MCOs) on October 15, 2020. In January 2021, contracts were awarded to Blue Cross and Blue Shield of Oklahoma, Oklahoma Complete Health, Humana Healthy Horizons, and UnitedHealthcare, with a go-live date set for October 2021.
The trajectory of these awarded contracts took an unexpected turn in June 2021. The Oklahoma Supreme Court invalidated the procurement process, asserting that the Oklahoma Health Care Authority (OHCA) was not authorized to award these contracts until May 27, 2021, thereby leading to the cancellation of the initially awarded contracts.
The state didn’t wait long, and on December 1, 2022, it reissued a request for proposal (RFP) to implement Medicaid managed care for the SoonerSelect and SoonerSelect Children’s Specialty Program. Proposals from interested organizations were due February 8, 2023, and were evaluated on 13 topics, including things like the operations plan, provider networks and services, covered benefits, and value-based payment, among others. However, the new RFP identified the partnership with providers as an essential and differentiating criterion in the award process.
The Rise of New Players in Managed Care
In June, OHCA announced that it awarded managed care contracts to Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma, and Oklahoma Complete Health. These contracts have positioned these entities at the forefront of the SoonerCare program and provide them the opportunity to manage the healthcare of about 800,000 Oklahomans that receive Medicaid through SoonerCare through an initial term ending June 30, 2025.
This move marks an essential step towards reshaping the healthcare landscape in the state, which has consistently ranked as one of the worst states in the nation for health outcomes. OHCA, is well aware of the reputation that Oklahoma has when it comes to the quality of care and health outcomes in the state.
“With these partnerships and this shift to SoonerSelect, we can change the course of health care in Oklahoma,” said Health Care Authority CEO Kevin Corbett. “I hope everybody believes that. We certainly do.” He also stated, “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.”
The overall goal of transitioning to managed care is to improve health outcomes for Oklahomans, moving towards value-based payment, containing costs by focusing on preventative and primary care, and increasing cost predictability. Over 40 other states have implemented managed care for their Medicaid programs, so there is plenty of evidence that it can help the state reach its specified goals.
SoonerSelect Utilizing Provider-Led Entities
One of the more unique aspects of Oklahoma’s second attempt at managed care is that all these organizations are provider-led entities. When OHCA released the RFP for their managed care program, it was stated that at least one of the contracts may be awarded to a provider-led entity (PLE). The PLEs would need to provide proof that a majority of their ownership is held by Oklahoma Medicaid providers or that the majority of the governing body is composed of individuals who have experience serving Medicaid members and are licensed providers.
However, all three of the entities meet the statutory requirements of being a provider-led entity. OHCA is also requiring these entities to contract with local Oklahoma provider organizations. A provider-led entity is a professional medical specialty society or other organization that is comprised primarily of providers or practitioners who, either within the organization or outside of the organization, predominantly provide direct patient care.
These entities are formed by providers that know what beneficiaries need and can meet the needs of individuals. These collaborative efforts are especially important when dealing with the IDD and LTSS communities. This will help ensure that beneficiaries in the state get the best care and see better health outcomes.
It’s great to see that Oklahoma stressed the need for provider-led entities because it strengthens the voice of local providers and allows them to leverage their expertise and experience with Oklahoma communities when delivering healthcare services to SoonerCare members.
Next Steps for Medicaid Managed Care in Oklahoma
The wheels of the SoonerSelect Medicaid Managed Care program have been set in motion with the award of these contracts. This critical phase will see the Oklahoma Health Care Authority, the state agency overseeing SoonerCare, working hand in hand with the contracted entities to ensure a seamless transition for SoonerCare members, without any compromise on the quality of care.
In the award announcement release, OHCA states that its staff will spend the next several months working with the three contract entities to ensure a smooth transition. Subject to contract approval from CMS, Oklahoma expects to launch the medical plans in April of 2024. This allows both OHCA and the contracted entities to get the proper networks and infrastructure, including technology, staffing, and research on best practices to coordinate care, in place.
The journey of Oklahoma towards managed care, while challenging, is showing some promise. It is refreshing to see an emphasis on provider-led entities, as this increases the experience that providers utilize to provide whole-person care. Historically, the proximity of providers to consumers improves satisfaction. With the combination of committed providers and experienced MCO’s the final outcome is likely to be more successful. We will keep a close eye on Oklahoma along with other states like New York, North Carolina and Arkansas who have similar approaches and report back with any significant developments or results.
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.