OKLAHOMA CITY — The Oklahoma Health Care Authority has released a Request for Proposal (RFP) for its new managed care program, SoonerSelect. OHCA is seeking proposals from qualified managed care organizations (MCOs) to implement a comprehensive managed care delivery system for certain SoonerCare members.
“Bringing expert managed care organizations from around the country to Oklahoma will provide better care and improve health outcomes for Oklahomans,” said Gov. Stitt. “I am excited the Oklahoma Health Care Authority is taking this step to further advance my vision of transforming Oklahoma into a Top Ten state.”
This transition in health care delivery will allow the State to achieve the following payment and delivery system reform goals: Improve health outcomes for Oklahomans, move toward value-based payment and away from payment based on volume, improve SoonerCare member satisfaction, contain costs through better coordinating services, and increase cost predictability to the State. Medicaid MCOs will administer Medicaid benefits and care coordination, including paying providers, similar to individual and employer plans in private sector.
“Managed health care in 2020 looks very different than it did in the early 2000’s when OHCA last contracted with MCOs to provide care coordination for SoonerCare members. Today, we have extensive federal managed care regulations, which means we will have the ability and full responsibility to make sure the plans are in compliance,” said Melody Anthony, State Medicaid Director and OHCA Chief Operating Officer. “Part of the contracting process between OHCA and MCOs will outline timely reporting of member feedback, network adequacy and claims data submission, which will include penalties for non-compliance. Additionally, the new federal managed care regulations have an extensive quality strategy with required health outcome reporting, which will help drive the agency’s ability to monitor progress on the program’s goals.”
Oklahoma joins 40 other states in engaging third-party managed care organizations to administer certain Medicaid benefits. States have reported positive outcomes, such as cost containment by investing in primary care and preventive services, as well as effective quality improvement strategies. MCOs have invested heavily in infrastructure, technology and research to allow Oklahoma to benefit from best practices in coordinating care for members. The MCOs will be required to have an Oklahoma presence including key staff and call center operations.
MCOs have the ability to provide value-added services not otherwise available through traditional SoonerCare. OHCA has spent an extensive amount of time working with experts around the county including other state Medicaid agencies to identify best practices and risk mitigation strategies.
“The reality is Oklahoma is ranked 46th in the country when it comes to healthcare. We can do better,” said OHCA CEO Kevin Corbett. “It’s incredibly important for all of us to stay focused on the task at hand, which is serving Oklahomans to our best ability.”
The RFP bidding process will end on Dec. 15, 2020. The contracts will be awarded and announced early next year. The MCOs anticipated implementation date is Oct. 1, 2021. For more information and updates about managed care in Oklahoma, visit http://okhca.org/SoonerSelect/.