Authors Posts by Fady Sahhar

Fady Sahhar

Fady Sahhar, PhD, is the Acting COO for ProVantaCare. He is responsible for managing the operations of the company, leading the contract development and negotiations with the Managed Care Organizations on behalf of owner providers. Fady works directly on the business development opportunities for ProVantaCare and is engaged in the advocacy of the RCPA Physical Disabilities and Aging Division.

Gateway Health plans will soon be Highmark Wholecare – same access to doctors, same commitment to care and whole-person approach to health. All that’s changing is the plan names. You can learn more about the transition to Highmark Wholecare, effective January 1, 2022, by visiting their website.


Message from the Office of Long-Term Living (OLTL):

This communication is a reminder that the Office of Long-Term Living (OLTL) is allowed to continue available temporary changes to the CHC waiver, OBRA waiver, and the Act 150 Program under Appendix K, Emergency Preparedness and Response, until six months after the end of the federal public health emergency related to COVID-19.

On October 15, 2021, the federal public health emergency was extended by 90 days; however, it’s possible the federal government will decide to extend the emergency further. Please visit this public health emergency website to see the current and future public health emergency declarations related to COVID-19. OLTL will issue guidance in the future when the Appendix K flexibilities are closer to expiring.

For further information on the available OLTL Appendix K flexibilities, please visit the OLTL Resources page. If you have questions about the information, please contact the OLTL Provider Helpline at 1-800-932-0939.

Photo by Markus Winkler on Unsplash

The Medical Assistance (MA) Bulletin posted on 10-22-2021 applies to all providers that render personal care services (PCS) to beneficiaries in the fee-for-service (FFS) delivery system, including Agency with Choice and Vendor Fiscal/Employer Agent financial management services organizations that provide PCS to MA participants who are enrolled in an Office of Developmental Program or Office of Long-Term Living waiver, the Act 150 Program, or a Community HealthChoices managed care organization.

The purpose of the bulletin is to:

  • Advise providers of updates to certain error status codes (ESC) for PCS subject to electronic visit verification (EVV), effective for claims received on and after October 22, 2021; and
  • Advise providers of an updated Provider Assistance Center (PAC) contact e-mail for their use.

Providers rendering PCS in the managed care delivery system should address any questions regarding ESCs for PCS subject to EVV with the applicable managed care organization.

Photo by Markus Winkler from Pexels

On September 28, 2021, AmeriHealth Caritas, which operates Medicaid managed care plans in 13 states and the District of Columbia, launched a new wholly-owned subsidiary called Social Determinants of Life, Inc. The subsidiary will invest in, support, and deploy solutions to help members build resilience, and help improve their health and create a path out of poverty. AmeriHealth Caritas is currently hiring for key leadership positions at the new company.

As the first step for Social Determinants of Life, Inc., AmeriHealth Caritas invested $29 million in Wider Circle in a $38 million funding round, becoming Wider Circle’s largest shareholder. Wider Circle is a California-based startup that builds tech-enabled, hyper-local health programs and peer-to-peer social networks. Its community care model is centered around trust, where culturally competent community engagement leaders and volunteer member ambassadors form groups with their neighbors to inform, support, and motivate one another to be more engaged and proactive about their health. Wider Circle is using the investment funds to continue developing and expanding its model. AmeriHealth Caritas has not released details about how Social Determinants of Life will leverage the Wider Circle model.

Commenting on the funding round, Darin Buxbaum, president and chief operating officer of Wider Circle said, “With the support of AmeriHealth Caritas’s new Social Determinants of Life, Inc., Blue Venture Fund and others, Wider Circle is well positioned to extend our proven hyper-local engagement model to improve health outcomes in communities nationwide.” Wider Circle offers programs to tens of thousands of members in more than 320 communities nationwide across the country

Wider Circle works with Medicare Advantage plans, Medicaid managed care organizations and capitated provider organization groups. The company seeks to align with the health plan sponsors through a per engaged member per month payment model. In this model, Wider Circle is paid for each actively engaged member as long as the member remains engaged in the Wider Circle group. The groups meet 10 or more times each year at favorite local public meeting spots, and connect on the phone every other week.

Wider Circle uses an evidence-based, data-driven approach to identify and group health plan members at the local level based on demographic and similar backgrounds. The company hires community engagement and outreach specialists from the same communities to invite health plan members to participate in the local groups. From there, neighbors help the group recruit other neighbors and open doors that would otherwise remain closed.

Trained facilitators build trusted groups of neighbors in a culturally competent manner by engaging members via weekly small-group meetings for six weeks. During this group formation period, the facilitators recruit and encourage able members to become volunteer “ambassadors” to help lead the group and ensure that members are informed about planned meetings and have access to the resources they need. To support the group leaders Wider Circle has employees in every community supported by Area Managers and state and account leadership.

After training, the group members support one another through tailored in-person and virtual interactions. The groups can meet in restaurants, parks, community centers, houses of worship, and other public gathering areas. The group members meet almost every month and chat on the phone every other week.

Wider Circle programs have helped Medicare and Medicaid plan members improve preventative care utilization and vaccine adoption rates while reducing hospital days. During the coronavirus disease 2019 (COVID-19) public health emergency, the Wider Circle groups supported participants facing isolation, delivered more than 180,000 meals, and helped participants access comprehensive social support services.

AmeriHealth Caritas serves nearly 5 million Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) members through its integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, and behavioral health services.

OPEN MINDS last reported on AmeriHealth Caritas in the following articles.

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