HealthChoices, Pennsylvania’s premier Medicaid Managed Care program, serves over 1.2 million of the Commonwealth’s most vulnerable low-income and disabled citizens.All members have a Primary Care Provider (PCP) who provides a Medical Home for the member and manages their medical care. The PCP makes referrals to specialists for care when medically necessary. Members have access to a wide range of specialists, hospitals, dentists, laboratory sites, therapists, home health providers, pharmacies, and other medical providers.
MCOs assist the PCPs and the members to obtain necessary care and receive preventive screenings and immunizations. The MCOs employ nurse case managers and social workers to provide Disease and Comprehensive Case Management to members with serious and/or chronic medical conditions so that they can maintain the best possible health status.
The HealthChoices Program has dramatically increased access to care from levels prevalent under the previous fee-for-service model. Active provider participation has been achieved through innovative payment practices and initiatives, regularly performing and acting upon provider network analysis, cultivating relationships with providers, and performing provider training and education. This program description was found on the the PA Coalition of Medical Assistance MCO's website.
HealthChoices MCOs incorporate the following payment model:
