Alternatives to Managed Care

We well-understand that each state has its own needs, culture and programming requirements. While most of our clients utilize managed care programming for their Medicaid population, we also bring vast experience working with clients who employ various alternatives to managed care. We have the operational protocols, reporting and management expertise to administer any program that is an alternative to managed care.

Primary Care Case Management (PCCM)

We are the only PCCM vendor in the country with over 30 years of experience serving millions of consumers in multiple states, including Pennsylvania (ACCESS Plus), Louisiana (CommunityCARE), West Virginia (Physician Assured Access System) and Illinois (Illinois Health Connect). With the support of our contract expertise, our clients have achieved national recognition and documented cost savings:

  • The ACCESS Plus Enhanced PCCM program in Pennsylvania, jointly administered by AHS and McKesson Health Solutions, was selected as one of the top 15 finalists for the Innovations for American Government Award through the Harvard Kennedy School Ash Institute for Democratic Governance & Innovation (2008).
  • Combined savings for the first two years of the ACCESS Plus PCCM program totaled $62.9 million.
  • The Illinois Health Connect PCCM program saved the state $531 million from 2007-2010; $140 million in 2009 alone, according to the Robert Graham Center.
  • The Illinois Health Connect PCCM Program was selected for the “Provider of the Year” award in 2010 by the Campaign for Better Health Care.
  • The ACCESS Plus Emergency Department Reduction Program resulted in a 34.8% decrease in ED visits over a three-year period.

Accountable Care Entity/Regional Care Organizations

Our experience providing services related to Accountable Care Entities and Regional Care Organizations provides us with deep understanding of the tools, resources and support that such entities require to focus on delivering high-quality care. We bring a rich toolbox of messaging, data transfers, panel rosters and back office operations to support our care delivery partners. Further, through decades of PCCM and related work, we understand the vital handoffs in consumer communication, and the need for accurate and timely data. We bring the tools and protocols to ensure full coordination so that the benefits of a holistic, integrated care model can be realized.

Care Delivery System Transitions

We pride ourselves on our flexibility in supporting our clients through monumental changes. We have supported clients in successfully transitioning from one delivery system to another. Our work includes supporting clients as they transitioned from fee-for-service to a PCCM model (Pennsylvania) and PCCM to managed care (Pennsylvania, Louisiana, and Illinois). We have also supported our clients with a range of alternative models, such as ACEs to managed care (Illinois). Perhaps our most noteworthy delivery system transition has involved supporting many of our clients during the rollout of the ACA. Our work has included educating and assisting Medicaid clients with understanding the new delivery system, how it compares to Medicaid and evaluating benefits. We have provided our clients with tracking and analysis to understand the impact of these changes on their population base.

“AHS provides substantial support to all of its staff which helps create successful leaders.”

Lisa Payne
Call Center Supervisor