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Oklahoma Medicaid’s transition to managed care will provide greater sustainability

As Oklahoma Medicaid transitions to a managed care model, providers and patients alike are feeling a palpable sense of anticipation and anxiety. This shift represents a significant opportunity to revolutionize the delivery of health care services in the state, delivering tangible benefits to providers and patients.

For providers, the transition to managed care offers a path to greater sustainability in an increasingly complex healthcare landscape. Medicaid reimbursement rates have long been a point of contention and often fell short of covering the actual costs of care. Managed care offers the opportunity to negotiate more favorable reimbursement agreements, ensuring that providers receive fair compensation for their services. In addition, select providers helping with Oklahoma’s transition to managed care will receive a temporary 19% increase in the base reimbursement schedule and an additional 9-10% increase to participate in the state’s Health Information Exchange (HIE).

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Patients will also benefit significantly from Oklahoma Medicaid’s transition to managed care. One of the most attractive benefits is the expansion of the rewards and benefits offered to members. For example, some managed care plans offer online mental health coaching, credit for opioid alternatives such as acupuncture and yoga, rewards for attending mental health appointments after a hospital stay, and support for teens experiencing loneliness and social experiencing isolation. Because managed care emphasizes preventive care and early intervention, patients are better positioned to manage chronic conditions and avoid costly hospitalizations and emergency room visits. By focusing on proactive, preventative measures, managed care can improve health outcomes, improve quality of life, and reduce healthcare costs in the long term.

In Oklahoma, rural communities face significant challenges in accessing health care services, including provider shortages and limited resources. Managed care can address these disparities by creating financial incentives and implementing innovative solutions, such as telehealth initiatives, to bridge the gap between patients and providers. By expanding access to a broader range of services, managed care ensures that all Oklahomans, regardless of location or socioeconomic status, can get the care they need when they need it.

Critics of Oklahoma’s managed care initiative have raised concerns about increased administrative burdens, the ongoing financial toll of the transition and fears that providers will leave the Medicaid network. These concerns are real, but help is available.

The Oklahoma Health Care Authority (OHCA) and the Managed Care Organizations (MCO) provider relations teams responded quickly to our concerns. Financial programs exist to minimize the economic impact on organizations, but providers must initiate the dialogue. Our experience operating in other managed care states, such as Colorado, provides optimism during this transition. We believe that managed care has fewer silos, fewer administrative burdens and greater financial opportunities.

In short, Oklahoma Medicaid’s transition to managed care holds tremendous promise for both providers and patients. By promoting greater stability, efficiency, and collaboration within the health care system, managed care can transform the delivery of health care services and improve health outcomes for Medicaid beneficiaries across the state. As we embark on this journey toward a more patient-centered, value-based healthcare system, let’s embrace the opportunities managed care provides and work together to build a healthier future for all Oklahomans.

Ron Lobato is the CEO of Alliance Mental Health, an outpatient mental health facility operating in Oklahoma and Colorado.