Amerigroup PCMH Pilot – TX

Region Within State: 
Houston (Harris, Montgomery, Waller, Fort Bend, Brazoria, Galveston)
Project Category: 
Insurer-Based
PROJECT STATUS
Target Start Date: 
Saturday, January 1, 2011
Pilot/Demo Length: 
1-2 Years

Our PCMH pilot is focused on transforming our delivery system and working more directly with providers of health care services to improve the quality and efficiency of the care delivered to Amerigroup members. Our most valuable resource for improving quality and controlling costs is our primary care network. The core of this strategy is focused upon devoting resources to our primary care providers to assist them in becoming highly functioning patient-centered medical homes within an integrated delivery system. This strategy requires a fundamental change in our relationship with providers to one of intense, on-the-ground collaboration.  Our model includes development of innovative payment models that reward value rather than volume.

Type of Practices: 
Other
CONVENING ENTITY/PROJECT CONTACTS
Convening Organization Name: 
Amerigroup Community Care
Primary Contact: 
Abby Lipskis
E-mail: 
Abigail.Lipskis@amerigroup.com
Phone: 
757.473.2737 x33984
Participating Stakeholders: 

Amerigroup

Participating Organization Types: 
Primary Care Practices
EXPECTED OR ACTUAL DEMOGRAPHICS OF PARTICIPATING PRACTICES
Number of Practices: 
45
Number of Participating Physicians: 
548
Physicians per practice: 
Varies from 1 to over 50
Types of Practices: 
Internal Medicine, Family Medicine, General Practice and Pediatrics
Health Plan Lines of Business Included: 
Medicaid MCO and Medicare Advantage
Overall Number of Covered Lives: 
122000
Technology Characteristics at Start of Pilot: 

Varies from paper record system to electronic medical records.

PRACTICE TRANSFORMATION SUPPORT (INCLUDING TECHNOLOGY)
Focal areas of transformation: 

Access to Care, Team based care, population management, care management, patient centered care.

Payment Model: 

 Participating primary care practices are paid their regular fee-for-service payments, but are eligible to receive additional compensation through a shared savings program including a quality threshold.

PROJECT EVALUATION
Types of data to be collected : 

Clinical quality measures, utilization data, medical costs data, access measures.

Which of the data types are being shared?: 

All of the above.

Relevant links: 

www.amerigroup.com