When you turn to AHS,
you are accessing experienced, comprehensive, health program management.
Primary Care Case Management
Burgeoning Medicaid budgets have literally mandated that Program administrators
implement policies and practices that have the potential for realizing long range
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
|2010 - 2012
||Department of Health and Hospitals
|2006 - Present
||Department of Healthcare and Human Services
||Illinois Health Connect development and administration
|2005 - 2010
||Department of Public Welfare
|2000 - 2016
||Department of Health and Human Resources
||Physician Assured Access System program administration
|1994 - 2005
||Department of Public Welfare
||Family Care Network program development and administration
From 2010 - 2012 AHS administered a Call Center for the Louisiana CommunityCARE
PCCM program housing four helplines:
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;
Specialty Care Resource Network Helpline through which AHS helped members
and providers locate and access specialty care;
Immunization Records Retrieval through which AHS responded to requests for
immunization records; and
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.
AHS also was responsible for quality management initiatives, provider recruitment
and credentialing, 24 hour accessibility monitoring, ongoing site visits. Further,
AHS had extensive responsibilities related to the Louisiana Medicaid hospice program.
We were responsible for reviewing all initial documentation and processing prior
authorizations for all Medicaid members on hospice.
Not only is this contract another example of AHS’ ability to provide a first-class
customer service experience, but it also demonstrates AHS’ ability to support the
State in changes to its Medicaid managed care model. In 2011, the State decided
to move the program to an enhanced PCCM program that included additional quality
and P4P measures, and AHS worked relentlessly to secure the Provider Attestation
Forms required for continued enrollment. Also in 2011, the State elected to implement
the BAYOU HEALTH program, a mandatory statewide managed care program, and AHS coordinated
with the State to ensure seamless transition of members to the new initiative.
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.
In addition to helping enrollees select a “best fit” medical home, AHS provides
a variety of enrollee education activities via the phone, field, mail and web. We
even produced a video available on our website – click the link to watch: IHC Client Education Video.
AHS also provides quality improvement activities, and in order to assist providers
in improving the quality of care for enrollees, Illinois Health Connect has developed
and made the following tools for providers:
- Panel Rosters
- Provider Profiles
- Provider Webinars
By continuing to work with all key players and offering multiple avenues through
which eligibles, providers, and stakeholders can reach PCCM staff, we have supported
the Program’s goals of: increased access to care, better coordination and continuity
(and thus quality) of care, increased provider participation, and improved enrollee
education and understanding about health-promoting behaviors.
More information about the Illinois Health Connect Project is available at www.illinoishealthconnect.com.
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.
Cognizant of the applicability of our EPSDT skill set, AHS’ top management began
to re-engineer our knowledge and experience in community environments, education,
network development, and information systems development to serve PCCM and HMO environments.
Subsequently, AHS was awarded a contract to design and implement the Pennsylvania
Family Care Network (FCN), a Primary Care Case Management model. This allowed us
to create a single coordinated managed care program for over 500,000 Medical Assistance
eligible children under the age of 21.
In 2005, McKesson Health Solutions was awarded the contract for DPW’s expanded PCCM
program called ACCESS Plus. ACCESS Plus replaced the Commonwealth’s former PCCM
program (the Family Care Network – FCN), and offered enhanced services such as care
coordination, intensive case management and disease management to an expanded population
of child and adult Enrollees. AHS administered all PCCM and ESPDT components as
a subcontractor to McKesson while McKesson administered the Disease Management component.