Medicaid HMOs Saved Pennsylvania $2.7 Billion
over the Last Five Years
Finds Pennsylvania's HealthChoices "a highly successful program, serving as a national model"
Harrisburg, PA - The Lewin Group released a new report today, Comparative Evaluation of Pennsylvania's HealthChoices Program and Fee-for-Service Program, finding that HealthChoices "is a highly successful program that appears to be working remarkably well for all stakeholders and to be delivering on all fronts." Based on The Lewin Group's analysis, HealthChoices has saved Pennsylvania more than $2.7 billion over the last five years.
The Lewin Group report, commissioned by the Pennsylvania Coalition of Medical Assistance Managed Care Organizations, is a first of its kind. To conduct this evaluation, The Lewin Group met with each of the seven managed care organizations participating in HealthChoices, interviewed advocates for their perspective on the HealthChoices Program, and spoke with staff at the Pennsylvania Department of Public Welfare.
The report focuses on four areas that contribute to a program's value - cost effectiveness, impact on access to health care services, quality of services provided, and approach to serving individuals with special needs. The report concludes that, on all fronts, HealthChoices is as effective a program that exists in the national Medicaid arena today, and is a valuable asset to Pennsylvania.
Cost Effectiveness - The report found that HealthChoices has performed exceedingly well and should serve as a national model. "This new report demonstrates that managed care approaches are having a favorable impact on care for thousands of medical assistance beneficiaries, and that this has benefited taxpayers in the process," says Karen Ignagni, President and CEO of America's Health Insurance Plans. "We should look to the plans in Pennsylvania as a model of innovation in Medicaid managed care and identify program that are working there that can be replicated elsewhere."
In addition:
- HealthChoices has held annual medical cost escalation to 7.4 percent over the past several years, compared to 10.4 percent in the Fee-for-Service program
Access - The report concludes the HealthChoices has many more and far superior "access initiatives" than any type of fee-for-service model, where physician participation, location, and cultural, language and other barriers exist for Medicaid members accessing health care.
HealthChoices managed care organizations enhance active provider participation through provider payment practices, value-added services and programs designed to increase access and numerous initiatives to invest in the communities where members live.
Quality - The report finds that, unlike Fee-for-Service, HealthChoices was designed as a system of care, incorporating strong quality management and improvement strategies, which lends itself to quality measurement. In addition, recent studies have reported that a general focus on quality and quality monitoring are much less important components of the primary care case management model than the capitated health plan model.
Serving Individuals with Special Needs - The report finds that unlike the Fee-for-Service model, which leaves individuals on their own to navigate a disconnected array of services, the integrated care coordination systems that the HealthChoices plans have created have significantly enhanced access and quality for special needs individuals. The care coordination systems include:
- Activities geared toward identifying individuals with special needs.
- Care coordination and case management approaches used to address the health and social issues and needs of the individuals.
- Disease management initiatives undertaken to provide a system of coordinated health care interventions for those with specific chronic conditions.
"The Lewin Report shows that Medicaid managed care works," says Thomas Johnson, Executive Director, Medicaid Health Plans of America. "In this day and age, any program that shows, quoting the report, 'massive savings', as well as demonstrates that it is superior to Medicaid Fee-for-Service in the areas of access, quality, and focus on special needs, brings great value to the state of Pennsylvania."
To view the report please go to to the Lewin Report.
For more information, please contact Michael Rosenstein at 717-234-1250.
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