Since the late 1970s, AHS' overall goal has been the promotion of health. The pursuit of this goal has been manifested in the development, implementation, and management of quality EPSDT programs for Medicaid eligible infants, children, and adolescents. Over two million children under the age of 21 have received comprehensive preventive health services through the programs we have administered in six states.

Encompassing all the elements of a complete EPSDT program (see Exhibit 2), our effort in Pennsylvania has produced the model used for all our EPSDT administration and has been our largest EPSDT endeavor. Contracting for these activities with the Commonwealth of Pennsylvania since 1980, we subsequently coordinated all aspects of the program and centralized operations by establishing a sole point of contact for all Pennsylvania consumers, agencies and providers. Utilizing a fully computerized system and using telemarketing-marketing capabilities, including a statewide toll-free hotline for consumers and providers, eligible families are contacted, educated about the program, and linked with a participating provider. AHS assists in scheduling appointments and transportation, and helps in identifying and linking consumers with follow-up care, as needed. See Pennsylvania EPSDT for a detailed description of these activities and experience.

1. Client Outreach and Education. Over the years, AHS has designed and implemented a host of creative outreach approaches. These reflect a continuum of possibilities, including face-to-face interactions with potential consumers in their homes or in welfare offices, to more productive methods such as networking with other agencies (i.e., Head Start and WIC) to increase the impact and scope of our outreach activities. We focus on cultural competency and assure that our consumer materials are produced at an appropriate literacy level. While our more than twenty years of direct EPSDT experience has resulted in a proven outreach and education model that helps assure that the maximum number of consumers eligible for the program receives the services to which they are entitled, we have successfully applied this experience to a variety of Programs across the country.
   
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2. Tracking System. While outreach and education are absolutely critical in meeting the goals of the EPSDT Program, there needs to be a mechanism that coordinates the activities of consumers, providers, and Program administrators. The mechanism used to do this -- the backbone of the telemarketing system -- is the consumer eligibility and periodicity tracking system AHS has developed. This proven approach, provides AHS staff have the ability to access a variety of eligibility and participation data on consumers, whole families, and providers at the touch of a button. Both EPSDT periodicity (including the provider and date of the exam) and current and historical eligibility can be checked as well as documenting the outcomes of outreach and appointment scheduling efforts. Our EPSDT management system also routinely generates a wide variety of time sensitive mailings to consumers that remind and educate them about EPSDT and follow-up services as well as satisfy Federal informing requirements.
   
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3. Referral and Follow-up. Referral and follow-up are the end result of the EPSDT screening process and are perhaps the most critical and difficult components to administer. The efficient and smooth operation of this effort is enabled by our customized and comprehensive Information Systems. We have a computer-based care coordination and follow-up system that ensures that the highest possible percentage of children needing follow-up promptly receive the medical care they require. We maintain a complete tracking history on thousands of children who need further diagnosis and/or treatment and referrals. This sophisticated design ensures that every child is given the opportunity to receive needed follow-up care and does not get lost in the system.
   
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4. Provider Recruitment and Network Maintenance. An important segment of our program administration has been the ability to recruit medical providers to participate in these efforts and also to monitor their adherence to stated protocols. This has required extensive training on all levels, ranging from group presentations to one-on-one training sessions involving a wide range of health professionals. After considerable cultivation and public relations, AHS staff has developed a network of trained EPSDT providers with whom we interact on a routine basis for quality evaluation, refresher training, problem solving and technical assistance. Our provider recruitment and training programs have been very effective:
   
   
   • we have increased our Pennsylvania provider base from approximately 600 active sites when AHS assumed statewide EPSDT administration to over 2,200 fully trained sites; and
   • 98% of all EPSDT claims submitted are ultimately approved and paid.
   
   
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5. Allied Agency Relations. Even before the enactment of OBRA '89 and widespread growth of mandatory Medicaid Managed Care Programs, AHS realized the importance of networking with community based agencies. We have been successful at establishing functional linkages with allied agencies that serve the Medical Assistance population and have similar goals and objectives (e.g., Head Start, WIC, Healthy Start, Healthy Mothers/Healthy Babies, March of Dimes, United Cerebral Palsy, ARC, etc.). Our objective in networking with other health and human service agencies is to enlist their help in "spreading the word" about the program, thus cost effectively multiplying our community outreach efforts and creating new sources of referral for our consumers. We, in turn, fulfill the same role for these other programs. As a result, services are promoted and better utilized, duplication of effort is reduced and service gaps are identified.
   
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   We maintain relationships with agencies at the state and local level, and offer in-service trainings which help agency staff more fully understand the workings of EPSDT and how they can effectively use the Program to help the families they serve. This includes advocacy of the Program to consumers; linking potentially eligible families to us via our toll-free number; promoting the Program to health providers; directly delivering screening, diagnostic, and/or treatment services; helping to provide case management (especially for hard-to-reach consumers), tracking, or referral to Program participants; and working toward the creation of needed services.
   
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6. Program Analysis and Reporting. The capability to process large quantities of data and generate accurate statistical reports is also essential to efficient program management, accountability, and evaluation. Through continual refinement, we have developed a comprehensive data processing system capable of satisfying Federal requirements and of streamlining state programs. Recognizing the need to be even more responsive to our customers and to provide more in-depth and detailed information about Program activities and outcomes, AHS is continuously developing new applications and incorporating new technology for use in its ongoing administration of the Pennsylvania EPSDT Program and in our other multi-state contracts.
   
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