PITTSBURGH, Aug. 30, 2016 /PRNewswire/ -- UPMC for
You announced that it has been selected to enter negotiations
for a multi-year agreement with the Pennsylvania Department of
Human Services (DHS) to offer services to more than 400,000 people
statewide who are dually eligible for Medicare and Medicaid or
receive Medicaid funded long-term services and supports
(LTSS). LTSS include both long-term care in a nursing
facility as well as community-based alternatives for older adults
and people with disabilities. The program is scheduled to
begin in July 2017 in Southwestern Pennsylvania, in Southeastern Pennsylvania in 2018 and
statewide by 2019.
This new program, Community HealthChoices (CHC), will coordinate
physical health care and LTSS to enhance the quality of life and
independence for frail seniors and adults with disabilities in the
least restrictive setting. Selected plans will be required to
offer Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs)
to further enhance coordinated care for participants choosing the
same plan for their Medicare and Medicaid coverage. UPMC for
Life Dual, UPMC for You' s D-SNP, serves 21,630 people
in 28 counties across western Pennsylvania. UPMC for
Life Dual is the largest stand-alone 4-Star D-SNP in the
nation.
Also, UPMC for You is the largest Medicaid plan in
western Pennsylvania, with a 37.9
percent increase in membership in 2015. It provides physical health
managed care benefits to more than 396,471 enrollees in 40
Pennsylvania counties in the
Southwest, Northwest, and Lehigh/Capital regions. UPMC for You is
also a top-rated Medicaid plan in Pennsylvania, with a rating of 4 out of 5 in
NCQA's Medicaid Health Insurance Plan Ratings 2016–2017.
"We are honored to have been chosen to offer these important
services to help people remain independent in the communities they
choose," said John Lovelace,
President of UPMC for You. "We applaud and support DHS's
efforts to move to this best practice and are happy to have the
opportunity to offer the best services and assistance for members
through our outstanding customer service." He adds, "UPMC for
You has a strong and proven track record serving dual
eligibles. CHC offers us the tools to further advance quality and
innovation statewide and improve health outcomes and quality of
life."
In addition to the quality of services for dual eligibles, UPMC
for You's plan is built on the foundation of UPMC's
integrated delivery system which includes providers across the
continuum of care. Additionally, UPMC for You' s
proposal embraces its roots in Pennsylvania and is building its CHC model of
care on local collaborations.
About UPMC for You
UPMC for You is an
integrated partner company of the UPMC Insurance Services Division,
which also includes UPMC Health Plan, UPMC for Life, UPMC
WorkPartners, UPMC for Kids, LifeSolutions, Askēsis
Development Group, eBenefits, and Community Care Behavioral Health.
The UPMC Insurance Services Division offers a full range of group
health insurance, Medicare, Children's Health Insurance Program,
Special Needs Plans, Medical Assistance, Commercial, behavioral
health, employee assistance, benefits administration solutions, and
workers' compensation products and services to over 2.9 million
members.
About NCQA
National Committee for Quality Assurance (NCQA) is a private,
non-profit organization dedicated to improving health care quality.
NCQA accredits and certifies a wide range of health care
organizations and recognizes clinicians in key clinical areas.
NCQA's HEDIS is the most widely used performance measurement tool
in health care. NCQA's website (www.ncqa.org) contains information
to help consumers, employers, and others make more informed health
care choices.
To view the original version on PR Newswire,
visit:http://www.prnewswire.com/news-releases/upmc-for-you-selected-by-the-commonwealth-of-pennsylvania-for-community-healthchoices-managed-care-agreement-300320474.html
SOURCE UPMC for You