SoonerCare Choice

Program Location: 
Oklahoma City, OK
Payer Type: 
State based

Reported Outcomes


The Oklahoma Health Care Authority implemented a patient-centered medical home primary care delivery system on January 1, 2009. The model incorporates a managed care component with traditional fee-for-service and incentive payments. It is Oklahoma's intent to build on the successes already achieved in SoonerCare Choice to establish a patient-centered medical home for all SoonerCare Choice members.

In the SoonerCare Choice program every member has a primary care provider whose office is considered their medical home. Some members also have a provider that is part of a HAN and therefore have access to increased care coordination.


  • Enhance patient choice and participation in health decisions; 
  • Assure all members receive all necessary preventive and primary care; 
  • Increase the provider network; 
  • Reduce inappropriate emergency department visits and hospitalizations; 
  • Realign payment incentives to improve cost effectiveness and quality; and 
  • Promote the use of health information.

All PCMH providers are required to provide 24-hour/7-day coverage by a medical professional. In addition, OHCA requires Tier 3 PCMH providers to provide extended office hours for members who aren’t able to visit them during normal hours. OHCA pays PCMH providers a monthly care management fee for their effort, which increases with every tier level. PCMH providers are also incentivized by SoonerExcel payments that are paid to providers for offering increased care coordination support and decreasing member nonemergent ER utilization. 

Payment Model: 

SoonerCare Choice Reimbursement Tiers:

Tier 1$3.46 to $4.85 PMPM range

12 requirements, including: Coordinated primary care and patient education; 24/7 telephone coverage by medical professional; Maintaining a system to track tests and referrals; Acceptance of electronic communication from OHCA

Tier 2: $4.50 to $6.32 PMPM range

19 requirements, including all Tier1 plus:  Full-time practice w/enhanced access/after-hours; Inpatient tracking & hospital followup; Any 3 of 6 optional enhanced services - practice healthcare team, after visit follow-up, adoption of evidence-based practice guidelines, medication reconciliation, MH screening 

Tier 3: $5.99 to $8.41 PMPM range

23 requirements, including all T1/T2 plus: Using health assessments tools to characterize patient needs and risks

Practices with an average caseload of 275 patients can expect to make:

  • $16,005 per year for Tier 1
  • $20,856 per year for Tier 2
  • $27,753 per year for Tier 3

SoonerCare Choice Program Independent Evaluation

Fewer ED / Hospital Visits: 
  • 12% reduction in ED visits
  • Statistically significant reduction in hospitalizations for congestive heart failure, COPD, and pnemonia
  • An estimated 61,000 avoided ED visits saved over $21 million in claim costs
Improved Health: 
  • Improved rate of treatmetn of asthma with appropriate medication among children and adolescents
  • Statistically significant increase in follow-up rate for enrollees hospitalized with a behavioral health condition (now over 40%)
Improved Patient/Clinician Satisfaction: 
  • High satisfaction with adult care (over 70% of respondents reported satisfaction with overall care)
  • Patient satsifaction for children increased all 4 years (85% in 2013) 
  • High provider satisfaction (approximately 91% of practice facilitation providers would recommend the program to a colleague)
Improved Access: 
  • Over 90% of children and adolescents had access to a primary care provider 
  • Childhood dental visits significantly above the national average 
  • Increase in acces to preventive/ambulatory services: 
    • 4.4% for adults age 20-44
    • 4% for adults age 45-64
Cost Savings: 


  • The SoonerCare Health Management Program and Health Access networks generated a ROI of 287.5%


  • Annual PMPM expenditure growth for the SoonerCare Choice population was 1.5 percent, half the average annual per capita national health expenditure increase of 3 percent over the same period.           
  • The ROI for the program in total through SFY 2013 was 562 percent.
Increased Preventive Services: 
  • Preventive service, screening and treatment rates improved for 4 HEDIS measures for children and adolescents 
  • Statistically significant improvement in 13 of 16 preventive and diagnostic services for enrollees with chronic conditions
Last updated April 2019
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