State of Oklahoma
The Pacific Health Policy Group (PHPG) was originally retained by the Oklahoma Legislature in 1994 to develp strategies for restructuring Oklahoma's nearly insolvent Medicaid program and to advise on options for enhancing the program's cost-effectiveness. Based on our recommendations, the legislature established a new Single State Agency - the Oklahoma Health Care Authority (OHCA) - and directed the agency to undertake a series of reforms, including development of rural and urban managed care systems and targeting program fraud and abuse, particularly within the behavioral health sector.
In the early years of the program, we assisted Oklahoma to obtain a Section 1115a Research and Demonstration waiver (SoonerCare) and to implement an innovative partial-capitation managed care program designed to overcome the state's historic lack of managed care outside of major urban centers.
PHPG helped to design the "O-EPIC" program, under which Oklahoma is using a portion of its waiver program savings, which now total $1 billion, to subsidize private insurance for small employers and low-income working families.
PHPG also assisted in the development of the nation's first ever American Indian PACE program, located in the Cherokee nation in eastern Oklahoma. Under the program, American Indians who qualify for Medicaid long-term care will have the option of enrolling in the PACE system, for which the state will be reimbursed at a 100 percent match rate.
In 2004-2005, PHPG was retained to assist in the enactment of “Insure Oklahoma”, an employer-sponsored insurance initiative, under which Oklahoma is using a portion of its waiver program savings to provide subsidies to low income workers in small firms. PHPG’s work included drafting the waiver proposal, preparing five year budget projections, briefing legislators and negotiating with the Centers for Medicare and Medicaid Services (CMS) on waiver terms and conditions. PHPG also helped to draft agency rules and state plan amendments associated with the waiver’s implementation. Additionally, PHPG assisted the state in obtaining approval from CMS to expand Oklahoma’s employer-sponsored insurance initiative to mid-size employers and college students.
In 2009, PHPG conducted an independent evaluation of “Focus on Excellence”, a voluntary, incentive-based payment and quality reporting system for Medicaid participating nursing facilities. PHPG assessed the appropriateness of the quality measures and incentive payment structure, as well as the usefulness of the information presented to consumers on the program website. PHPG also compared Focus on Excellence to pay-for-performance systems and consumer websites in other states and at the federal level.
In 2009 PHPG completed an independent evaluation of the OHCA’s development and implementation of “No Wrong Door” – a web-based Medicaid application available to partner state agencies and individual applicants.
PHPG is conducting a multi-year independent evaluation of the SoonerCare Health Management Program (HMP), an intensive care management initiative for persons with chronic medical conditions. PHPG is examining the program’s performance with respect to improvement in quality of care, member and provider satisfaction and impact on utilization and health care costs.
PHPG is conducting an independent evaluation of the SoonerCare Prenatal Tobacco Cessation Initiative, under which pre-natal care providers are receiving training on best practices for reducing tobacco use among pregnant and postpartum patients.
