Improving health and healthcare one network connection at a time... Copyright 2011, Sooner Health Access Network.

Copyright 2011, Sooner Health Access Network

Improving health and healthcare one network connection at a time . . .


The Opportunity

• Need to increase access to care– Build a network of SoonerCare Providers

• Primary Care• All Specialties (including behavioral health)• Other Services

• Poor consumption of social services– Incorporate Social Services into:

• Clinical Practice• Everyday lives


The Opportunity

• SoonerCare Patient Centered Medical HomeReduce barriers to achieve tier status

• Tools to enable practices• Operational Design• Assist practices with PCMH audits• QA / QI Projects at macro and micro level• Health Literacy• Care Coordination• Disease Management & Interventions• Prevention


The HAN: What is it?

An organization selected by OHCA to:• Increase Member access by assembling a network of

SoonerCare Providers that incorporates Social Services• Assist Providers with meeting Tier 3 PCMH Status and

Achieving Meaningful Use• Provide technology and support to achieve those goals and

improve patient care quality• Provide improved access to specialists and specialty care

for their SoonerCare patients• Provide targeted Care Management for selected

populations

Care CoordinationLoop Closure

• Lack of care coordination, especially surrounding care transitions– Relationship between PCP and specialists has eroded– Volume drives workflows on both sides– Non-clinical personnel drive much of the referral process– Significant numbers of unnecessary visits happen, and

important necessary visits are delayed or missed entirely– No effective way to monitor quality surrounding care

transitions


Care Coordination

• Provide free software tool to improve care coordination

• Two components:– Clerk2Clerk: provides accurate and easy

management of patient referrals and tracking, 24/7 access to specialists

– Doc2Doc: Enables direct provider to provider conversations about patient cases . . . Some of which are eligible for reimbursement


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Status Changed FROM (Phase) by Week; Last Quarter

VR InitiationSchedulingVisitConsult In ProgressVR CompleteVR Final CompleteVR Failed(blank)


Telemedicine Interactions

• Currently under pilot• Working with OHCA to gain approval for new fee

schedule for Store and Forward Telemedicine– Get 24/7 access to specialists for online

consultations– Gain insight into patient movements around the

healthcare system– when to see them back– Get paid to have electronic consultations with

specialists

The question/case is here.

The answer is here.Specialist

PCP




Data, Data, Data

• Development of Clinical Analytics Platform• Only group to have full claims data set• Beacon, NQF, HEDIS Measures• Ability to do meaningful and targeted

performance improvement projects• Mechanism for practices to define performance

improvement projects and measure their own performance without investing the analytics resources


Better reporting: Data you care about

Prospectively Identify Care Gaps:• Identify those in need of screens, refills,

treatments• Follow up on ER visits• Better communication between providers• Improved efficiency in the office All drive & improve business, as well as improve patient outcomes


Enhanced Data Access

• Data provided by HAN from OHCA specific to your population: ER, cancer screening needs, etc.


2009-12 2010-01 2010-02 2010-03 2010-04 2010-05 2010-06 2010-07 2010-08 2010-09 2010-10

-60

-40

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0

20

40

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80 Month to Month Population Changes

IM

2010-08 2010-090

5

10

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30Top 7 ED Providers by Month

Claremore Regional Hospit

Hillcrest Medical Center

Jane Phillips Ep Hsp

Oklahoma State University Medical Center

Saint Francis Hospital

Southcrest Hospital

St John Med Ctr

What is happening to my SoonerCare enrollment over time?

Where are my SoonerCare patients getting ED care?


Care Management

Dedicated team of Care Managers to serve you and your patients. Focused on:• Hemophilia• Breast Cancer• Cervical Cancer• High Risk Pregnancy• Persistent ER Utilizers• Pharmacy Lock-In




Lessons Learned

• Relationships are critical• Behavioral comorbidities are key• Social support is a necessity• Clinical & community services must be aligned• You have to go to them• Tomorrow is more important than today• Comprehensive view of member is required

– MyHealth / Beacon


One Year In

• Approximate enrollment: 35,000 Members• Over 689 Providers have joined• Over 20,000 Referrals using Care Coordination

Tool• Completed or Active Care Management: 200• Establishment of Hemophilia Clinic• 100% Viable Birth Rate in HROB Program• Continued Growth of Network• Expansion of Care Management Interventions


Who qualifies for this program?

• All Sooner Care Providers• Appropriate licensures and certifications in

place to practice• Appropriate med-mal and other insurances in

place


How do my members get service?

1. Complete the initial application form2. Review the Sooner HAN Membership

Agreement3. Sign the Membership Agreement4. Communicate your goals to HAN (increase Tier

level, better manage specific populations, etc.)5. Training of staff and providers6. Participate


More Information?

Matthew ClarkOU School of Community [email protected]

mailto:[email protected]

Improving health and healthcare one network connection at a time... Copyright 2011, Sooner Health Access Network.

Documents

patient care quality

provider complete

improved access

member access

provider response

patient outcomes copyright

specialty care

care gaps