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Automated-Health Systems
The Enlightened Choice
in Health Service Management
Primary Care Case Management

Family
Burgeoning Medicaid budgets have literally mandated that Program administrators implement policies and practices that have the potential for realizing long range cost savings.

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. Additional information about these contracts is provided below.

AHS' PCCM Contracts
Time Period Location Contracting Agency Program
2010 - 2012 Louisiana Department of Health and Hospitals CommunityCARE
2006 - Present Illinois Department of Healthcare and Human Services Illinois Health Connect development and administration
2005 - 2010 Pennsylvania Department of Public Welfare ACCESS Plus
2000 - 2016 West Virginia Department of Health and Human Resources Physician Assured Access System program administration
1994 - 2005 Pennsylvania Department of Public Welfare Family Care Network program development and administration
Louisiana CommunityCARE

From 2010 - 2012 AHS administered a Call Center for the Louisiana CommunityCARE PCCM program housing four helplines:

  1. Enrollee Helpline through which AHS assisted with linkages to medical homes, medical home linkage change and disenrollment requests, and outreached on several topics related to accessing care. We operated a special provider queue to assist providers with questions related to panel management;
  2. Specialty Care Resource Network Helpline through which AHS helped members and providers locate and access specialty care;
  3. Immunization Records Retrieval through which AHS responded to requests for immunization records; and
  4. Nurse Triage and Education Helpline through which AHS (through a subcontract with McKesson Health Solutions) provided clinical education and supports members in making informed decisions about their care.
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Illinois Health Connect Primary Care Case Management Project (Illinois Health Connect)

In 2006 AHS was selected as the Illinois Health Connect Project Administrator, and as such was charged with developing and implementing the roll-out plan for Illinois’ new PCCM initiative. During the implementation period we not only built a call center, customized HealthTrack (AHS’ proprietary health administration management system) and hired and trained staff, but we also recruited a network of over 5,000 medical homes to provide care for Medicaid eligibles. On an ongoing basis, AHS is responsible for providing outreach, education, and enrollment assistance to new eligibles across the State on an ongoing basis and supporting providers serving as medical homes under Illinois Health Connect.
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Pennsylvania ACCESS Plus

From 1980- 2010 AHS has provided a variety of services to the Pennsylvania Department of Public Welfare (DPW). Initially the work included administration of the Commonwealth’s EPSDT Program that covered over 1,000,000 eligible children and adolescents per year. AHS was responsible for outreach and education, provider recruitment, care coordination, and claims processing. By providing DPW with a high quality, low-cost solution, as well as through the merit of our excellent track record, AHS was awarded the contract in 1983, 1987, and 1992.
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