Sept. 24--By March of next year, those who rely on Medicaid -- the government health insurance program for low-income people -- must choose a "managed care" provider, and in Luzerne County that means one of three companies: locally established Geisinger, nationally available Coventry Health Care, and a new partnership between AmeriHealth Mercy Health Plan and Hospital Service Association of Northeastern Pennsylvania.
The two joined to form AmeriHealth Northeast and won approval to serve as the third option for Medicaid patients in the 22 counties of what the state calls the "New East Zone."
"By March 1 of next year, fee-for-service Medicaid will be no more," AmeriHealth Executive Director Marge Angello said, referring to the policy of paying a set Medicaid payment for a given service. "The (Pennsylvania) Department of Public Welfare did a lot of analysis and felt members enrolled in managed care do much better and are healthier and have a better quality of life."
All Medicaid participants must choose among the three competing managed care providers. If a choice is not made, the Medicaid client will be assigned to a provider. Angello said there are about 212,000 eligible members in the "New East Zone."
Managed Care providers must offer a large enough network of physicians and medical services to satisfy state requirements. Once a person picks a provider, he or she is expected to use doctors and facilities within that provider's network. By keeping all patient services within a single network, costs should stay lower while improving continuity of care.
As Medicaid clients comparison shop, the differences between the three managed care providers will be which doctors are in which networks, and differences in program details.
"All the plans have to have benefits that are pretty consistent across the board," Angello said. "We may have a change in vision or dental coverage to give more access, or we may offer programs," such as including hospital visits in a diabetes program.
AmeriHealth has offered Medicaid managed care elsewhere in the state, but is expanding into this region. "I'm very excited about coming up there and being able to work with our providers, to get constituents enrolled in our plan. We know we do a very good job and we have a very strong mission to care for the poor and fragile population."
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