Health Care Reform

Behavioral health issues rarely occur in a vacuum. Many individuals with behavioral health needs also suffer from chronic physical ailments, including diabetes, asthma, and heart disease. This CHCS blog, The Thrust to Integrate Behavioral Health Services in Medicaid, highlights how policymakers are increasingly focused on the need to better coordinate care for this population. It outlines emerging state and federal efforts that are moving toward whole-person care on many fronts — including programs to integrate physical and behavioral health services, reduce homelessness, end the cycle of repeat jail visits, and, ultimately, improve this vulnerable population’s overall quality of life.

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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

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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Below is the RFI to which RCPA submitted comments, which can be seen here.

From: DHS STAKEHOLDERS On Behalf Of HS, Secretary’s Office
Sent: Friday, May 29, 2015 2:38 PM
Subject: [DHS-STAKEHOLDERS] HealthChoices RFI Issued

Dear Stakeholders:

Today the Department of Human Services (DHS) is releasing a Request for Information (RFI) and we want your input. We are soliciting information that will assist with the development of a Request for Proposal (RFP) for a HealthChoices Physical Health services procurement. The overall goal of which is to explore new innovative approaches to the delivery and payment of health care services that reward quality and increase access within the Medicaid program.

HealthChoices is the name of Pennsylvania’s managed care programs for Medical Assistance (MA) recipients. Through Managed Care Organizations (MCO), recipients receive quality medical care and timely access to all appropriate physical health services, whether the services are delivered on an inpatient or outpatient basis. DHS has three simple goals for HealthChoices:  improve access to health care services for MA recipients, improve the quality of health care available to MA recipients, and stabilize our MA spending.

As DHS looks to make improvements to Pennsylvania’s HealthChoices program, we are interested in ideas and approaches we should consider to accomplish the following:

  • Promote the achievement of the Triple AIM (better health, better care, lower cost)
  • Improve care coordination between physical and behavioral health services
  • Promote the expansion of value based purchasing of health care services
  • Promote the expansion of team based approaches to care delivery (for example- patient centered care medical homes)
  • Promote community based public health initiatives
  • Increase consumer access to needed services, especially in rural and underserved areas of the Commonwealth
  • Improve the efficiency of the HealthChoices program
  • Improve the provider experience with the HealthChoices program

I encourage you to provide feedback by close of business on June 26, 2015. Please submit your responses electronically to RA-PWHCRFIResponses@pa.gov, and thank you, in advance, for taking the time to provide your valuable input.

With your unique perspectives and input, we look forward to improving a system that provides quality services for our most vulnerable Pennsylvanians.

The RFI is available at www.emarketplace.state.pa.us/Solicitations.aspx?SID=DHS%20HC%20RFI%202015.



Ted Dallas
Acting Secretary
Department of Human Services

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On June 30 the American College of Physicians issued a position paper calling for better integration of behavioral health into primary care; The Integration of Care for Mental Health, Substance Abuse and Other Behavioral Health Conditions into Primary Care: American College of Physicians Position Paper. It provides an environmental scan of the current state of conditions included in the concept of behavioral health, and examines the arguments for and barriers to increased integration into primary care. It also examines various approaches of integrated care delivery and offers a series of policy recommendations that are based on the reviewed information and evidence to inform the actions of the American College of Physicians and its members regarding advocacy, research, and practice. A summary of the paper is in today’s Annals of Internal Medicine online edition.

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The Medicare-Medicaid Coordination Office (MMCO), in the Centers for Medicare & Medicaid Services (CMS), is dedicated to ensuring that beneficiaries enrolled in Medicare and Medicaid have access to seamless, high-quality health care, that includes the full range of covered services in both programs. MMCO recently shared an array of tools and resources on integrated health care. This office works with the Medicare and Medicaid programs, federal agencies, states, and other stakeholders, to align and coordinate benefits between the two programs effectively and efficiently, ultimately improving the way Medicare-Medicaid enrollees receive health care.

What is Integrating Primary Care Services into Behavioral Health Settings?

  • Within the context of primary care and behavioral health care, full integration exists when all care providers work together to address the primary care and behavioral health needs of individuals in the same setting.
  • There are several integration levels; some organizations may introduce elements of primary care into their practices, or decide to develop a fully integrated system without going through any of the other levels.

Why Integrate Primary Care Services into Behavioral Health Organizations?

  • Organizations that move along the integration continuum may be able to improve the care they provide to their consumers while increasing the efficiency of care delivery.
  • Organizations that adopt some of these strategies may also benefit from such increased efficiencies, which may translate into reduced health spending for specific target populations.

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