HealthChoices Central

What is HealthChoices?

HealthChoices is Pennsylvania's innovative mandatory managed care program for Medical Assistance (MA) consumers. The program is designed to improve access to and quality of care for MA consumers throughout Pennsylvania.

HealthChoices, designed by the Pennsylvania Department of Public Welfare, is one of the most successful managed care programs for MA consumers in the nation. For thousands of consumers, the HealthChoices program gives guaranteed access to primary and preventive care for the first time by providing a medical home, also known as a Primary Care Provider (PCP). The program's design and administrative structure result from over twenty years of MA experience with voluntary and mandatory managed care. Some highlights of the HealthChoices program include:

HealthChoices Improve Access: HealthChoices improves access to and coordination of care by providing a guaranteed medical home for every consumer. All consumers in HealthChoices have access to primary and preventative care through a PCP. For thousands of consumers, the HealthChoices program has provided guaranteed access to primary and preventive care for the first time. In addition, it ensures access to wide variety of specialty providers, which have been historically difficult to find in the traditional Medicaid fee-for-service (FFS) program.

HealthChoices Increases Quality: HealthChoices increases quality of care by ending consumers' need to rely on emergency rooms for basic primary care services and actively managing the care consumers receive. Each managed care plan establishes annual goals for improving its members' health. HealthChoices plans have improved immunization rates, decreased hospital admissions, decreased number of deliveries of premature infants and increased numbers of members receiving appropriate care for chest pain.

HealthChoices Serves Nearly All MA Consumers: By enrolling nearly all MA eligibility categories, persons with special needs are integrated into our mainstream managed care program. This enables these persons to use the same broad array of providers, including specialists, as everyone else.

HealthChoices Assists Persons with Special Needs: HealthChoices addresses thousands of consumers' special needs through the Special Needs Units, a feature unique to this program and found in no other commercial or publicly funded managed care program in the nation.

HealthChoices Depends on Public Input: HealthChoices has been designed and continues to be improved through an extensive and ongoing public input process.

HealthChoices Works in Rural Areas: HealthChoices has already been successfully implemented in several rural counties in the Commonwealth. For example, based on experience from prior implementations, consumers in rural areas often have access to primary and preventive care through PCP for the first time when enrolled in HealthChoices.

 

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