Welcome to the Oklahoma Rise 25 and 25 RHTP podcast. In this episode we take a deep dive into the Community Health Worker (CHW) Expansion in Hospitals Initiative — a five-year, $10.8 million Rural Health Transformation Program investment designed to hire, train, and deploy 30 hospital-based CHWs across rural Oklahoma.

You hosts conferred with RHTP Task Force experts and policy strategists to unpack why this program is far more than a staffing grant: it is a proof-of-concept designed to generate auditable, payer-ready ROI that will enable long-term Medicaid and commercial reimbursement. We walk through the lead agency role of the Oklahoma Health Care Authority (OHCA), the uncompensated care fund reimbursement model ($69,000 per CHW per year), and the FY2026–FY2030 timeline and stage-based milestones.

Topics covered include the operational design (hospital and ED embedding, recruitment of local CHWs, rigorous training, and mandatory caseloads), the four core program components (recruiting and training, hiring and deployment, defined hospital settings, and monitoring/reporting), and the mandated service focus areas: behavioral health referrals, housing and social determinant screening, and nutrition/food security connections.

The episode explains the critical data and infrastructure dependencies — the Community Care Referral Platform, the consumer-facing monitoring tools, and the Building Health Data Utility (HIE) — and how CHWs act as the human agents who convert data alerts into real-world interventions. We highlight cross-pillar linkages with Clinical Integration Networks, community paramedicine, and chronic disease management programs that are essential for closing referral loops and validating outcomes.

Key performance targets and accountability requirements are discussed in detail: a 10% reduction in readmissions among multi-visit patients by years three to five, a phased utilization requirement (50% in years 1–2 rising to 100% in years 3–5), and mandatory, high-quality outcome tracking to support a State Plan Amendment (SPA) for Medicaid coverage. The episode draws on comparable evidence from Arkansas (significant Medicaid savings via HCBS diversion) and Texas (ED-based CHW reductions in ED visits) to model the expected ROI.

We also examine the major execution risks — hospital partner readiness and administrative capacity, CHW quality and training, reliable data collection and HIE interoperability, and proactive payer engagement — and the two immediate FY2026 priorities: OHCA’s rigorous selection of priority hospitals and activation of the uncompensated care fund to enable on-time recruitment and deployment.

Listeners will gain actionable insight into what hospital leaders, policymakers, and community stakeholders must do to translate $10.8 million into sustainable system change: treat the CHW not as a temporary hire but as the central node of an upstream prevention model, build the data pipeline to demonstrate auditable savings, and engage payers early to secure permanent reimbursement. This episode frames the CHW expansion as a potential turning point for rural Oklahoma’s financial and clinical stability — if execution matches the ambition.

Listeners are invited to join the Oklahoma Rise 25 in 25 RHTP Task Force at Rise25in25.org or email info@rise25in25.org for more information. The Oklahoma Rise 25 and 25 RHTP Forum is produced and directed by Dr. Keley John Booth, MD.

Welcome to the Oklahoma RISE 25 and 25 RHTP podcast. In this episode Dr. Booth and guests from the Oklahoma RISE 25 and the Oklahoma State Department of Health (OSDH) take a deep dive into the Consumer‑Facing Technology for Chronic Disease Prevention and Management and Behavioral Health Initiative — a nearly $16 million, five‑year effort to meet rural Oklahomans where they already are: on their phones.

We explain the initiative’s strategic placement within the RHTP “moving upstream” pillar, and how the program’s core mission—the billable service sustainability model—requires rigorous, independently validated ROI within five years so successful pilots can be transitioned to permanent payer coverage. The episode covers the budget ($15,950,000 across FY2026–FY2030), OSDH’s administrative role, and the disciplined, phased timeline that leads to payer engagement in FY2030 and possible regulatory pathways in FY2031.

Listeners will learn how the technology works in practice: app‑based conversational AI assistants that deliver personalized coaching, micro‑interventions, automated reminders, gamification, and tangible incentives; tightly filtered clinical alerts that trigger community health workers (CHWs) or providers; and integration with chronic disease management curricula, the statewide community care referral platform for SDOH, and the health information exchange (HIE) for population analytics.

The episode focuses on three priority populations—maternal health (prenatal/postnatal care and postpartum depression screening), behavioral health (CBT‑informed digital coaching, PHQ‑9 screening and crisis triage), and aging dual‑eligible patients with complex chronic needs—and explains why these groups offer both urgent need and high potential ROI. We discuss concrete performance targets (notably a 25% DAU/MAU stickiness goal and alert thresholds of ~5–10% readings triggering risk alerts with only 1–3% requiring immediate human action) and the technical, cultural, and workforce measures planned to reach them.

The episode also outlines governance and execution: the essential advisory council with rural residents and lived‑experience representation, OSDH’s requirement for a dedicated project manager (1.0 FTE) to run procurement and evaluation, and the front‑loaded investment in technical assistance and RFP development to avoid premature, ineffective buys. You’ll hear about the independent evaluation requirement that will quantify cost avoidance (hospitalizations, ER visits, complications) and the sequencing risk if pilots are rushed or adoption is low.

We finish by laying out the five critical success factors: authentic community engagement, achieving the 25% stickiness target, successful provider/CHW integration and workflow redesign, independent ROI demonstration, and effective payer engagement to secure sustainable coverage. The episode leaves stakeholders with clear near‑term priorities for FY2026: form the advisory council, complete needs assessments, design robust RFPs, and focus recruitment and training so the program can prove its case and avoid the five‑year cliff.

Listeners are invited to join the Oklahoma Rise 25 in 25 RHTP Task Force at Rise25in25.org or email info@rise25in25.org for more information. The Oklahoma Rise 25 and 25 RHTP Forum is produced and directed by Dr. Keley John Booth, MD.

In this episode of the Oklahoma RISE 25 and 25 RHTP podcast. Today we take a deep dive into the Building Health Data Utility pillar of the Oklahoma Rural Health Transformation Program — specifically the $29,210,000 Health Information Exchange (HIE) interoperability initiative led by the Oklahoma Health Care Authority through its OKShine office. Covering all 77 counties and deployed across FY2026–FY2030, the initiative is presented as the critical, foundational “data plumbing” required to unlock the rest of the states $1.1 billion rural health investment.

Hosts discuss the core problem — fragmented patient data and severe rural blind spots — and unpack sobering baseline metrics: 97% of rural health clinics (RHCs) are not connected to the HIE, 46% of rural hospitals lack integration, 40% of substance abuse treatment centers are unconnected, and a statewide 20% duplicate diagnostic testing rate. The episode explains how these gaps create patient-safety risks, wasted spending, and a lack of timely population-level visibility for state decision-makers.

The conversation outlines the initiatives two central marching orders: extend HIE connectivity to unconnected rural facilities, and dramatically expand data ingestion to include imaging, pharmacy, public health, and real-time mortality feeds. It details the four funded components — facility connection and onboarding subsidies, provider adoption and education (including a peer-to-peer learning portal), system upgrades and data integration (notably $2.5M for AI-driven imaging over-reads and a DICOM server), and a consumer-facing consent application to resolve Oklahomas opt-in policy for behavioral health data — and the specific facility targets: ~40 rural hospitals, 139 RHCs, 304 long-term care facilities, and 4 substance-abuse treatment centers.

Listeners are walked through procurement and cost models (tiered connection costs with most expenses contractual), the required tie-ins with parallel investments (EHR expansion at $44.88M and data & analytics expansion at $21.7M), and the sustainability gamble: a five-year grant runway followed by a provider-assumed maintenance payment model beginning Q4 FY2031. Key milestones and timeline are called out — launch of connection subsidies in Q3 FY2026, a regional ingestion pilot by Q2 FY2027, peer portal by Q4 FY2027, full statewide availability by Q1 FY2029, and the transition to provider payments in FY2031.

The episode highlights measurable targets and performance metrics — 50% RHC HIE penetration by years 4–5, at least a 15% relative reduction in duplicate testing, and 100% county-level access to imaging/public health/mortality feeds by year five — and flags the highest risks: failure to demonstrate ROI to providers before the billing transition, procurement delays for critical infrastructure (the DICOM server), challenges in deploying a trusted behavioral-health consent app, and the need for flawless coordination with the EHR expansion. It closes by connecting these technical and policy elements to the everyday impact for rural Oklahomans: fewer duplicate tests, faster transitions of care, stronger data for value-based payment and population health, and reduced administrative burden for rural clinicians.

Listeners are invited to join the Oklahoma Rise 25 in 25 RHTP Task Force at Rise25in25.org or email info@rise25in25.org for more information. The Oklahoma Rise 25 and 25 RHTP Forum is produced and directed by Dr. Keley John Booth, MD.