Tags Posts tagged with "HealthChoices"

HealthChoices

During the past few years, the state Medicaid program, HealthChoices, has begun to implement and expand the use of Value-Based Purchasing models in procurement contracts with all Physical Health Managed Care Organizations (PH-MCOs). With a goal of increasing clinical outcomes, patient satisfaction, and cost management, the PH-MCOs have called for increased use of such Value-Based Purchasing models as Pay for Performance, Patient Centered Medical Homes, and Bundled Payments. On May 25, the leadership of the Offices of Medical Assistance Programs (OMAP) and Mental Health and Substance Abuse Services (OMHSAS) conducted a webcast to review the implementation process used in HealthChoices by the PH-MCOs and their provider networks, and to introduce the process of expanding Value-Based Purchasing to the Behavioral Health Managed Care Organizations and their provider networks. The OMHSAS target for introducing this expansion is January, 2018 with a focus on integrated and collaborative behavioral and physical health and care coordination.

Today the Wolf Administration issued a document entitled Understanding Community HealthChoices vs HealthChoices to explain the similarities and differences between the two programs.

Community HealthChoices (CHC) is a new initiative that will increase opportunities for older Pennsylvanians and individuals with physical disabilities to remain in their homes. HealthChoices is Pennsylvania’s mandatory managed care program for 2.2 million Medical Assistance participants.

CHC was developed to: (1) enhance access to and improve coordination of medical care and; (2) create a person-driven, long-term support system in which people have choice, control, and access to a full array of quality services that provide independence, health, and quality of life. Long-Term Services and Supports help eligible individuals to perform daily activities in their homes such as bathing, dressing, preparing meals, and administering medications.

The document describes eligibility, timelines for implementation, and the CHC managed care organizations that will operate in each zone beginning in January, 2018.

From: “HS, Secretary’s Office”
Date: January 5, 2017 at 1:01:56 PM EST
To: “DHS-STAKEHOLDERS@LISTSERV.DPW.STATE.PA.US”
Subject: [DHS-STAKEHOLDERS] DHS Awards Medicaid Agreements

Department of Human Services (DHS) Secretary Ted Dallas announced that DHS has agreed to move forward and negotiate agreements with six managed care organizations (MCOs) to deliver physical health services to Pennsylvanians through HealthChoices, Pennsylvania’s mandatory Medicaid managed care program since 1997.

“These agreements will be the most significant changes to Pennsylvania’s Medicaid program since we moved to managed care two decades ago,” said Dallas. “Over the next three years, MCOs will be investing billions of dollars in innovative approaches that reward high-quality care that improves patient health rather than just providing services for a fee.”

The $12 billion, three-year contracts include a 30 percent target for payments based on value received or outcomes, rather than on the quantity of services provided.

The MCOs were selected based on several criteria, including their current performance, the level of customer service delivered, member satisfaction, and their value-based performance plan. Performance criteria measured, among other things, management of chronic conditions such as high blood pressure, diabetes, and asthma; frequency of prenatal and post-partum care; and access to preventive services.

“The average performance ratings of the selected organizations are consistently higher than the current averages in every region. This transition will result in higher levels of quality care for the 2.2 million Pennsylvanians served by Medicaid,” said Dallas.

To drive Pennsylvania’s Medicaid system towards these better outcomes, the three-year agreements set gradual targets for all MCOs to increase the percentage of value-based or outcome-based provider contracts they have with hospitals, doctors, and other providers to 30 percent of the medical funds they receive from DHS. The result will be that billions in funds that would have otherwise been spent on traditional payment arrangements will instead be invested in outcome or value-based options such as:

  • Accountable care organizations (voluntary networks of hospitals, doctors, and other providers that work together to provide coordinated care to patients);
  • Bundled payments (increases value-based purchasing);
  • Patient-centered medical homes; and
  • Other performance-based payments.

“We’re going to reward folks for providing the right services, not just more services. You get what you pay for so we’re shifting the focus of Pennsylvania’s Medicaid system toward paying providers based on the quality, rather than the quantity of care they give patients,” said Dallas. “In addition, by focusing on improving the health of consumers, we will drive down the cost of care and ultimately save the taxpayer funds we spend on health care in Pennsylvania.”

HealthChoices delivers quality medical care and timely access to all appropriate services to 2.2 million children, individuals with disabilities, pregnant women, and low-income Pennsylvanians.

For more information, visit www.HealthChoicesPA.com or www.dhs.pa.gov.

DHS has selected the following MCOs to proceed with negotiations to deliver services in Pennsylvania beginning in June 2017. The agreements are awarded in five geographic regions:

Southeast Region Gateway Health
Health Partners Plans
PA Health and Wellness
UPMC for You
Vista–Keystone First Health Plan
Southwest Region Gateway Health
PA Health and Wellness
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Lehigh/Capital Region Gateway Health
Geisinger Health Plan
Health Partners Plans
PA Health and Wellness
Northeast Region Gateway Health
Geisinger Health Plan
UPMC for You
Northwest Region Gateway Health
UPMC for You
Vista—AmeriHealth Caritas Health Plan

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Pennsylvania Continues Shift to Outcome and Value-based Payment Structure

On April 27, Department of Human Services (DHS) Secretary Ted Dallas announced that the state has agreed to move forward and negotiate contracts with eight managed care organizations (MCOs) to deliver physical health services to Pennsylvanians through HealthChoices, Pennsylvania’s mandatory Medicaid managed care program since 1997.

“These agreements mark the most significant change in Pennsylvania’s Medicaid program since we moved to managed care 18 years ago,” said Dallas. “Over the next three years, MCOs will be investing billions of dollars in innovative approaches that reward high-quality care that improves patient health rather than just providing services for a fee. The result will be higher levels of quality care for the 2.1 million Pennsylvanians served by Medicaid.”

HealthChoices delivers quality medical care and timely access to all appropriate services to children, individuals with disabilities, pregnant women, and low-income Pennsylvanians. For more information, visit the HealthChoices website or DHS website.

DHS has selected the following MCOs to proceed with negotiations to deliver services in Pennsylvania beginning in 2017. The agreements are awarded in five geographic regions:

Southeast Region

 

Centene (Pennsylvania Health and Wellness)
Health Partners Plans
United Healthcare of Pennsylvania, Inc.
UPMC for You, Inc.
Vista–Keystone First Health Plan
Lehigh/Capital Region Centene (Pennsylvania Health and Wellness)
Gateway Health
United Healthcare of Pennsylvania, Inc.
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Southwest Region

 

Centene (Pennsylvania Health and Wellness)
Gateway Health
United Healthcare of Pennsylvania, Inc.
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Northwest Region Aetna Better Health of Pennsylvania
United Healthcare of Pennsylvania, Inc.
UPMC for You
Vista—AmeriHealth Caritas Health Plan
Northeast Region Geisinger Health Plan
United Healthcare of Pennsylvania, Inc.
UPMC for You
Vista—AmeriHealth Caritas Health Plan

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On September 15, 2015, an Info was issued regarding a webinar the Office of Long-Term Living (OLTL) will be holding on provider credentialing for Community HealthChoices. The registration link for this webinar sent by OLTL was incorrect. Please use the corrected link below to register for the webinar.

The Office of Long-Term Living (OLTL) will be holding a webinar on Wednesday, September 30, 2015, from 8:30 – 10:00 am for Home and Community Based Services providers and Service Coordination Entities interested in participating in Pennsylvania’s planned Managed Long Term Services and Supports (MLTSS) program, now known as Community HealthChoices. The purpose of the webinar is to provide a high level overview of OLTL’s current provider credentialing process, to obtain input on credentialing MLTSS providers, and to discuss how the provider credentialing process may look for Community HealthChoices. Information on how to access the webinar can be found below.

  1. Please join my Webinar.
    https://global.gotowebinar.com/register/152791275
  2. You will be connected to audio using your computer’s microphone and speakers (VoIP).  A headset is recommended. Or, you may select “Use Telephone” after joining the webinar.

Dial +1 (631) 992-3221
Access Code: 787-398-715
Audio PIN: Shown after joining the webinar
Webinar ID: 103-329-483

For questions regarding this email, please contact the OLTL Provider Inquiry Line at (800) 932-0939.

On May 29, the Department of Human Services released a request for information (RFI) to help guide the department’s planning process for the release of a new procurement for the provision of managed care services for physical health. RCPA submitted comments and recommendations to the department in response to the RFI. Secretary Dallas has worked to be transparent during this process and has published a summary of some of the most frequently provided comments in the responses to the RFI. He has also identified some of the changes that the department is considering for the new HealthChoices physical health managed care procurement. This list is not intended to be final and merely reflects some of the ideas that are being considered at this time. Because many of the comments and related action plans communicated by Secretary Dallas address integrated physical and behavioral health care, data and information sharing, service system simplification, and other initiatives that have implications for RCPA members, this interim report is being shared at this time. Please submit any additional comments on the concepts included in this summary, or an area that is not listed in the document, via email by August 10.

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The Department of Human Services has prepared training/informational guides to help providers, business and community partners in the transition to the new HealthChoices Expansion Program. These were added to the HealthChoicesPA.com website under the Provider Information tab.

Included are the following:

  • Eligibility Verification System
  • Benefit Package Coverage and Limits
  • Transition Plans
  • Continuity of Care
  • Template for Resources
  • Recipient Benefit Package
  • Copayments
  • Health Screening