The Oklahoma Primary Healthcare Extension Program

Just as the cooperative extension dramatically improved food production and distribution, the primary healthcare extension system (PHES) is expected to improve the quality of primary health care available to Oklahomans, reduce the cost of care and health insurance premiums, and improve the health of the population. Greater visibility and alignment of local health improvement initiatives will increase their efficiency and effectiveness and leverage funding from a broader range of sources. The PHES has three components, a state hub, four regional extension centers in the Area Health Education Centers (AHECs), and approximately 70 county health improvement organizations (CHIOs). Each of these components already exists, but all will have to be strengthened for the system to be successful.


State Hub
The Public Health Institute of Oklahoma (PHIO) is a non-profit organization established in 2004 to “promote health through collaboration among government, academia, and communities.” Its Board of Directors includes representatives from public health, primary care, academic medical centers, hospitals, the Oklahoma Health Care Authority (OHCA), and community-based organizations. PHIO has agreed to serve as the state hub for the extension system. PHIO is one of 29 PHIs throughout the United States.


Regional Extension Centers
The four regional AHECs will become experts in primary care quality improvement methods. They will hire, deploy, and supervise practice facilitators (PFs) working with primary care practices in each county. The AHECs will also maintain close relationships with faculty in the academic health centers and primary care residency programs (which will provide educational support to the practices) and with the regional universities that train health professionals. This relatively new role for the AHECs will comfortably complement their other health professional development and support activities.


County Health Improvement Organizations (CHIOs)
A certification program offered by PHIO will strengthen and increase the visibility of existing Turning Point partnerships and/or other community-based coalitions (e.g., Sooner Success and Wellness Now) by helping them to become 501c3 non-profit (“neutral convener”) organizations, putting them in a better position to attract both public and private funding. CHIOs will also be able to hire or contract with care managers, community health workers, mental health professionals, and others who will expand the capabilities of the primary care practices, working collaboratively with them and with other community organizations.


Benefits to Various Stakeholders

Primary Care Clinicians/Practices

  • Survival of small, independent primary care practices
  • Support for QI; adoption of research discoveries and best practices
  • Access to resources (care managers, mental health, and information technologies)
  • Harmonization of QI indicators and reporting requirements

State Government and the Citizens of Oklahoma

  • Greater access to high-quality primary health care improving overall care at a reduced cost
  • Stronger Turning Point partnerships and/or other local coalitions
  • Better alignment of resources resulting in greater efficiency and smaller government
  • More leveraged funding for health improvement (federal, foundation, and corporate)
  • Creation and/or support for up to 250 jobs spread equitably across the state
  • Improved population health

Oklahoma State Department of Health (OSDH)

  • Additional resources to strengthen local partnerships
  • Enhanced effectiveness of state and local efforts to improve health and health care
  • Access to more complete health and health care data
  • Opportunity to better align public health and primary health care

Oklahoma Health Care Authority (OHCA)

  • A statewide system supporting PCMHs similar to the Health Access Networks
  • Greater willingness of primary care practices to accept Medicaid patients
  • Reduced cost due to improved access, improved quality, and better alignment

Oklahoma Department of Mental Health and Substance Abuse

  • Potential to improve screening/management of mental health problems in primary care
  • Access to additional sources of staffing and funding through collaboration


  • Opportunity to collaborate on community health improvement plans
  • A possible less expensive alternative to accountable care organizations (ACOs)

Educational Institutions (Medicine, Nursing, Social Work, and Public Health)

  • Creation of up to 140 additional preceptorship opportunities for students
  • More practical and efficient translation of research findings into practice
  • Increased funding opportunities for health system improvement and medical research

Health Insurance Companies

  • A statewide system from which care management and QI services could be purchased
  • A possible way to meet the Minimum Loss Ratio provision of the Affordable Care Act


  • Increased worker productivity and reduced absenteeism as a result of better primary care
  • Lower health insurance premiums as a result of improved population health

The Oklahoma Foundation for Medical Quality (OFMQ)

  • Increased competitiveness for federal contracts and grants
  • Enhanced ability to meet the required scope of work benchmarks