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Pa. regulator awards Medicaid agreements to 8 managed care organizations

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Pa. regulator awards Medicaid agreements to 8 managed care organizations

The Pennsylvania Department of Human Services has agreed to moveforward and negotiate contracts with eight managed care organizations to providephysical health services to Pennsylvanians through the state's mandatory Medicaidmanaged care program, HealthChoices.

The department has selected Centene (Pennsylvania Health andWellness), Health Partners Plans Inc.,UnitedHealthcare of Pennsylvania Inc.,UPMC For You Inc. andVista-Keystone First Health Plan to proceed with negotiations to provide servicesin the Southeast region.

Pennsylvania Health and Wellness,Gateway Health, UnitedHealthcare of Pennsylvania, UPMC for You and Vista-AmeriHealthCaritas Health Plan were selected for the Lehigh/Capital and Southwest regions.

Aetna Better Health of Pennsylvania, UnitedHealthcare of Pennsylvania,UPMC for You and Vista-AmeriHealth Caritas Health Plan were selected for the Northwestregion; and Geisinger Health Plan,UnitedHealthcare of Pennsylvania, UPMC for You, and Vista-AmeriHealth Caritas HealthPlan were selected for the Northeast region.

The three-year agreements set gradual targets for all managedcare organizations to increase the percentage of value-based or outcome-based providercontracts they have with hospitals, doctors and other providers to 30% of the medicalfunds they receive from the department. As a result, more than $6 billion in fundsthat would have otherwise been spent on traditional fee-for-service arrangementswill instead be invested in outcome- or value-based options such as accountablecare organizations, bundled payments, patient-centered medical homes and other performance-basedpayments, according to an April 27 news release.