Copyright 2011, Sooner Health Access Network
Improving health and healthcare one network connection at a time . . .
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
3/28/2010
3/21/2010
3/14/2010
3/7/2010
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2/14/2010
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0 200 400 600 800 1000 1200 1400 1600 1800
Status Changed FROM (Phase) by Week; Last Quarter
VR InitiationSchedulingVisitConsult In ProgressVR CompleteVR Final CompleteVR Failed(blank)
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
Copyright 2011, Sooner Health Access Network
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
Enhanced Data Access
• Data provided by HAN from OHCA specific to your population: ER, cancer screening needs, etc.
Copyright 2011, Sooner Health Access Network
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
60
80 Month to Month Population Changes
IM
2010-08 2010-090
5
10
15
20
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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?
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
Copyright 2011, Sooner Health Access Network
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
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
Copyright 2011, Sooner Health Access Network
More Information?
Matthew ClarkOU School of Community [email protected]