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Tags Posts tagged with "physical health managed care"

physical health managed care

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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 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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