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Managing care in Medicaid managed care.

Mike Fogarty¹, Garth L Splinter, L Carter Kimble

¹Oklahoma Health Care Authority, Oklahoma City, Oklahoma 73107, USA. carter.kimble@okhca.org

The Journal of Ambulatory Care Management

|June 11, 2013

Summary

Oklahoma

Area of Science:

Health Services Research
Public Health Policy
Healthcare Management

Background:

Oklahoma's Medicaid program, SoonerCare, transitioned from fee-for-service.
The program evolved into a commercial managed care system and then a medical home model.
This evolution aimed to improve service delivery and cost-efficiency.

Purpose of the Study:

To detail the transformation of Oklahoma's Medicaid program, SoonerCare.
To explain the current program structure and utilization control methods.
To outline future directions for system improvement in Oklahoma's Medicaid.

Main Methods:

Descriptive commentary on program evolution.
Analysis of current program features and patient interventions.

Related Experiment Videos

Discussion of strategies for quality and efficiency enhancement.

Main Results:

SoonerCare has undergone significant structural changes.
The Oklahoma Health Care Authority employs various interventions for utilization control.
The program is in its early stages, with ongoing efforts for refinement.

Conclusions:

The transition to a medical home model represents a significant shift for SoonerCare.
Continuous improvement is key to ensuring quality, appropriate, and efficient Medicaid services.
Future efforts will focus on building upon the current system's successes.