MCOs to slash SoonerCare hospital utilization

Posted on: 12/18/20

The Oklahoma Health Care Authority (OHCA) held an actuarial bidders’ conference Monday, Dec. 14, for health plans interested in bidding on the “SoonerSelect” managed care request for proposals (RFP).  

OHCA issued the SoonerSelect RFP on Oct. 15 as directed by Gov. Kevin Stitt. The state of Oklahoma intends to contract with managed care organizations (MCOs) to deliver health care services to most SoonerCare (Medicaid) enrollees, including children, parents, and the new “expansion” group of eligibles added by the passage of State Question 802 on June 30. Proposals by MCO plans were due Dec. 15.  The SoonerSelect program is planned to begin Oct. 1, 2021.  

The conference was presented by Mark Nordstrom with Mercer, OHCA’s actuarial consultant, and focused on draft capitation rates: the per member, per month amounts OHCA will pay to the plans awarded an MCO contract. The draft capitation rates had been released on Dec. 7.

Mercer’s assumptions in setting the SoonerSelect capitation rates included significant reductions in utilization of health services. Inpatient hospital and emergency room utilization were both assumed to be reduced for most enrollees by 40%, with behavioral health utilization reduced by 20%. In answer to a question, Nordstrom said these utilization reductions are expected to occur immediately when the contract begins, rather than being achieved over time.



OHCA plans to award at least two statewide SoonerSelect contracts to MCOs on Feb. 1, 2021.

Mercer’s full presentation slide deck is available on the OHCA website. This and other documents related to the SoonerSelect RFP are located here. (Rick Snyder)