In mid June the Oklahoma Health Care Authority (OHCA) announced it would seek proposals from managed care organizations (MCOs) to improve health outcomes and access to care for Oklahoma’s Medicaid population in October of 2020. OHCA is in the process of developing the request for proposal, and in doing so requested public feedback on what considerations needed to be included in the proposal. HMPI took the opportunity to provide feedback, as there are many things to consider when switching the Medicaid population to MCOs. Below is a summary of HMPI’s feedback and our full comments can be accessed through the hyperlink.
Background on RPF Response: Commercial MCOs
Healthy Minds Policy Initiative offers this response to a Request for Public Feedback (RPF) by the Oklahoma Health Care Authority (OHCA) about a proposal to shift the SoonerCare (Medicaid) program to a comprehensive commercial managed care model. This is a broad summary of our feedback, and our complete feedback is available here.
What is a comprehensive managed care model?
Private insurance organizations would be hired by the State to act on the State’s behalf to issue insurance coverage to Medicaid enrollees under a value-based payment system intended to reduce overall costs to the State. In return for assuming the risk of insuring Oklahoma’s Medicaid population, these Managed Care Organizations (MCOs) would attempt to earn a profit by ensuring their State funding — overhead and a monthly payment per enrollee — exceeds the costs of providing care.
Can this model work in Oklahoma?
Our comments are not intended to represent a comprehensive analysis of this model’s viability in Oklahoma. However, we offer the following considerations relevant to the Request for Public Feedback:
Can this model work for mental health and addiction coverage?
What should we consider about the current model?
Our RPF response is not intended to represent a thorough analysis of Medicaid management in Oklahoma. However, Oklahoma’s existing structure of Medicaid administration, managed directly and split between OHCA and ODMHSAS, has impressive financial and outcomes advantages that should not be ignored. We cite two examples, although there are many more:
How can the State accomplish its goals?
In addressing each question raised in the State’s RPF, we offer suggestions that can be used to improve value-based care whether as part of a commercial MCO model or its current system. Our RPF response addresses issues such as:
Quality and Accountability
Care management and coordination
Provider Payments and Services