UPMC Medicaid organization expanding

WILLIAMSPORT — UPMC for You, a Medicaid Managed Care Organization (MCO), will be expanding at the beginning of September.

The University of Pittsburgh Medical Center (UPMC) held a virtual news conference Monday to highlight what the expansion of the organization means for Medicaid-eligible individuals and families. It was noted that maps of areas served will soon change, adding to potential membership figures.

UPMC for You will serve a Northeast Zone and a Southeast Zone, rather than dividing the service area into three parts.

John G. Lovelace, UPMC Insurance Services Division Government Programs president, said the integrated approach of UPMC for You is meant to address health inequities with UPMC's record of engagement with community groups.

Lovelace says the UPMC bid included some extras in addition to the standard benefits of Medicaid, such as elimination of co-pays for drugs. He said it would be a significant relief for people facing out-of-pocket prescription costs.

"We also have a no-cost fixed transportation if you use are using public transportation in the northeast and southeast zones," Lovelace added. "If you use transportation for anything, the state provides medical assistance transportation for trips to medical centers, business transportation, which people can use to to go to work to go to the livrary or anything. You can get that by calling our medical services folks."

Lovelace says the network of physicians and hospitals in the plan is extensive, and includes Geisinger. A 24-hour nurse advice line also permits members to call for practical medical advice at any time. Telemedicine will also allow service from most mobile devices.

Dr. Johanna Vidal-Phelan, chief medical officer of the Quality Department at the UPMC Insurance Services Division and clinical assistant professor of pediatrics at the University of Pittsburgh School of Medicine, says significant strategies are already in place to reach the Spanish-speaking community.

"My team has been doing a lot of work and collaboration, especially in the Philadelphia area," Vidal-Phelan said. "During the COVID-19 pandemic we provided increased sources of information to the Spanish-speaking community about COVID-19 and COVID-19 vaccinations."

Vidal-Phelan notes that they are building relationships with community based organizations now in the Latino community.

"Federal health centers are of critical importance," Vidal-Phelan says. "We are building networks with our

Telephone services in Spanish, provided by a member services team, is a source of pride as it's a resource and outreach provided by someone who understands the member's first language.

Events, including some via Spanish language electronic media, are also playing a role.

"It is really important that events like this and others reach the community and really share who we are in a new market," Vidal-Phelan notes. "We really care about this conversation and that we can share the time today."

The UPMC For You website is also available in Spanish.

Dr. James Schuster, chief medical officer for the UPMC Insurance Services Division, says that the division was created to meet the needs of providers as well as members.

"We have staff that go out and work with providers," Schuster says. "We look at our data to try to understand where there might be challenges for providers or members. We also work to develop reimbursement strategies for providers which allow them to address the chronic health needs of members."

UPMC for You is a one of a variety of insurance companies in the UPMC insurance division. It is a nonprofit corporation.