Continuing changes in the health care system have prompted states to alter their approach to the delivery of services to low-income families. Burgeoning Medicaid budgets have literally mandated that Program administrators implement policies and practices that have the potential for realizing long range cost savings. Cost saving is a critical factor, but assuring that the families being served actually have access to the services is as important. To address these needs, many states have turned to Primary Care Case Management.

In 1993, this was the route the Pennsylvania Department of Public Welfare chose to take when they applied for, and received, a Federal waiver to develop and administer a Primary Care Case Management program. Because of our association with EPSDT in Pennsylvania over the 13 previous years, AHS was chosen to administer this new endeavor called the Family Care Network (FCN). Moving into the managed care arena was a logical step for the company. The infrastructure for developing such a program was already in place, and our years of experience in managing other large-scale programs more than adequately prepared us for the task at hand. Then in 2005 Automated Health Systems, in partnership with McKesson Health Solutions, successfully bid on an expanded PCCM program in Pennsylvania called ACCESS Plus. At the time ACCESS Plus was the largest fully integrated Medicaid PCCM and disease management program in the country. Since that time two other states, Illinois and Louisiana selected Automated Health Systems to administer PCCM projects for their Medicaid Programs as well. In Illinois, AHS worked closely with the State and Provider groups to develop the Illinois Health Connect (IHC) Program. Although the project was started from scratch, IHC currently serves over 2 million Medicaid consumers with a network of close to 5,500 PCPs. Several of the program’s major accomplishments have been the development of secure web site that allows consumers to actually enroll on-line, an on-line referral system for providers, and secure access for providers to view paid claims for members of their provider panel. AHS has also assumed the management of the state of Louisiana’s Community Care (PCCM) and KIDMED(EPSDT) programs. Currently we serve close to 1million Medicaid consumers and manage a network of 1000 PCCM and EPSDT providers. We are also in the final stages of developing an on-line enrollment process for the Community Care program as well.