Software provider discusses ‘nightmare’ transition from SoonerCare to managed care

Collaborator: Rachael Schuit
Published: 06/13/2024, 5:29 AM
Edited: 06/21/2024, 3:32 AM

(OKLAHOMA CITY, Okla.) The impact of the switch from SoonerCare to Managed Care has caused a mental healthcare crisis for Oklahomans. 

In May, VNN Oklahoma interviewed two counselors who discussed the difficulties of staying in business due to payment issues.

The situation also led Clyde Wafford, President of OrionNet Systems (an electronic health records company that provides ThinkHealth Systems Software to about 150 mental health agencies in Oklahoma) to speak out. 

Wafford sent an email to the head of the Oklahoma Healthcare Authority in April calling for a solution. He also told VNN Oklahoma that the seven agencies his company provided services to had to shut down because of these payment problems. 

Wafford said the closure of those seven agencies meant the loss of 100 jobs. 

One agency leader who had to shut down told Wafford: “It’s really sad because I’ve already lost everything,” Wafford said. “Funds might help me go pay the rent on the building I have, but funds won’t get those commissions back…[for] who have already lost faith in me over a process that I had no control over, who [have] lost faith over the process as a whole.”

Wafford told us he believes a lack of preparation was a major cause in the crisis that has been ongoing. 

“In November, Oklahoma Complete Health started working with people to put them on a roster, but Humana and Aetna did not,” Wafford explained. “It was almost like these organizations wanted to wait [until] the very last minute to do any work. They wanted their money–as much as they could get–before they had to hire any staff or anybody…that’s just my perception.”

Wafford added that the Oklahoma Healthcare Authority should have looked to other states that had been through a transition like this for guidance. For example, OrionNet Systems also provides services in the state of Ohio and went through this kind of adjustment seven years ago in a much smoother way, according to Wafford.

Ohio Medicaid, “told the MCEs (Managed Care Entities) what would occur, and when the MCEs were not doing everything fast enough, they put a halt on it and didn’t pay them until they fixed everything,” Wafford said. “They essentially stalled the rollout and said, ‘Nope, you’re not ready, so we’re not paying you until you get ready,’ and that made it so much easier, I think, on the agencies.” 

For months, the team at OrionNet systems has been working around the clock to assist the agencies they serve and help them keep their doors open. 

“We’re IT people. We understand software,” said Wafford. “What we do now is…we call agencies and say, ‘Hey, let me use your account and I will get on and check your Availity, I will check your pace fan, I will check your Echo, I’ll make sure everything’s hooked up correctly. I’ll tell you where there’s issues.”

Wafford told VNN that while things have started to improve, accountability around these transition-related issues is still needed.

Oklahoma Senator David Bullard (R-Durant) held a press conference at the state Capitol last week to listen to those impacted by the managed care transition challenges and demand action from the managed care organizations regarding the reimbursement delays. 

“Without swift and decisive action, we will watch our health care providers leave Oklahoma, to the detriment of all our residents,” Bullard said. “I am watching closely how the Health Care Authority and the managed care organizations respond to this call to action.”

Bullard said health care providers who are having Medicaid billing issues as a result of managed care should contact their state lawmakers, the Oklahoma Health Care Authority and the managed care organizations contracted with the state.

“To my providers in the state, do not stay quiet,” Bullard said. “Hold us accountable for our failures. Thank you for the care you provide Oklahomans.”


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