Oklahoma’s Medicaid program, SoonerCare, is on its way to profound change. StateImpact’s Catherine Sweeney talked with its director, Secretary of Health Kevin Corbett, this week about the transition to managed care.
Right now, SoonerCare works on a fee-for-service model, where the state pays providers like doctors and hospitals directly. Gov. Kevin Stitt's Administration has worked to usher in managed care, a model that brings insurance companies in to manage members’ health coverage. That new program will be called SoonerSelect.
(This interview was condensed for brevity.)
Catherine Sweeney, StateImpact health reporter: For our listeners who might not know, can we talk a little bit about who qualifies for Medicaid and kind of what the point of that program is?
Secretary of Health Kevin Corbett: So Medicaid is for those individuals that are not financially resourceful to be able to acquire health care on their own. So this is a group of individuals that meet a certain level of income, typically anything but about 138% or lower of the federal poverty limit. Give you some perspectives on that. For an individual that’s less than $18,000 a year in income for a family of four or less than $40,000
Sweeney: What is SoonerSelect? Just to catch anybody up who maybe wasn’t aware. Can we talk just a little bit about what the goal for that is?
Corbett: I’ll use a little history, if that’s okay. I mean, yeah, it’s important to recognize where we are as a state with regards to health and health outcomes. We’re 48th in the country today in health rankings. What we haven’t been able to do is really crack the code with regards to how do we improve health outcomes for at least the members that we serve. And today that’s 1.3 million.
So we are moving to a — I’ll call it a delivery system change — from what we call a fee-for-service business .. to an outcome-based program that really measures the success, based on how well people are receiving health care, but at the same time, “How is their health improving?”
Sweeney: So can we talk a little bit about what fee for service looks like and how long that’s been around and why Oklahoma is trying to move away from that?
Corbett: We have 70,000 providers that are agreed to contract and provide services to our Medicaid members. And there is an agreement made in terms of what the compensation might be for the services they provide. When we start again thinking about what was the progress or lack thereof that we were making with regards to health outcomes. We said, “What else could we do and what are others having success with?” And so managed care has been around for a long period of time. For the most part, social determinant-type services are not allowable under a fee for service, but we know that they need to be addressed. They may be 80% of the reasons why health conditions exist today.
Sweeney: Listeners might not know the term “social determinants of health.” Can we define that term?
Corbett: It could be living conditions, you know, inappropriate living conditions. It could be food insecurity issues, it could be family issues, if you will. So everything that you can think about that could have an impact on your decisions of how you might think about your health and having to make tough decisions
Sweeney: When I’ve talked with health policy analysts and people out of state about managed care versus fee for service, that is kind of the biggest pro that they offer, is that it allows states to invest in these social determinants of health in a way that isn’t possible elsewhere. One of the biggest criticisms that I hear is — and we’ve seen that in lawsuits in other states, Ohio, a few others — how is Oklahoma kind of hedging against that kind of issue where these companies can kind of inflate costs or do other things that, you know, don’t responsibly spend taxpayer dollars?
Corbett: Fair, fair question. … That’s going to be the role of the health care authority to ensure that all of those things are operating at our expectations and our set of standards. You know, part of it starts with picking the right partners, setting the right expectations and having the right checks and balances in place as an oversight function. So that is on us to make sure.
Sweeney: Where is (health care authority) in getting, you know, federal approval and and the in the bid process kind of just a check in?
Corbett: So the first step was to obviously have authority to do this. We have that. We have three request for proposals. One was a dental program, another was the medical program, let’s say the mental (health and) medical, and dental. And then it was a children’s specialty program. So we just awarded the dental program. And we will close the response time for the medical and specialty children’s program on February 8th.
And right now we believe that period of time will take us up to April of 24 before we’re able to kind of launch the program, if you will, allow people to start to enroll in the in the desired health plans they have and start to receive service by being coordinated with these health plans.
