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Dayton Business Journal...
CareSource may
gain as Ohio shifts Medicaid providers
by Laura Englehart
Friday, April 6, 2012
CareSource, one of Dayton’s largest companies, has the potential to
increase its Medicaid recipient membership base.
The Ohio Department of Job and Family Services announced Friday it has
chosen CareSource as one of five contractors statewide who will be
authorized to provide services to Medicaid recipients, part of a plan
to help improve health care for low-income residents.
Starting Jan. 1, Ohio will combine its eight Medicaid managed care
service regions into three — west, central/southeast and northeast.
When the new structure takes hold, CareSource likely will compete with
fewer managed care providers and pick up more members, though
executives said they cannot estimate how many at this time. CareSource
already operates statewide.
“Our main concern will be that all members have access and an easy
transition, and while there is the possibility for growth, we couldn’t
begin to make any estimate,” said Pamela Morris, president and CEO of
CareSource.
CareSource has more than 1,000 employees locally. It is among the
largest companies in the Dayton region with $2.8 billion in annual
revenue in 2011.
The company serves more than 900,000 members across Ohio and Michigan.
All eight regions currently have two to three providers and the state
has nearly 40 separate health care plan arrangements. The new structure
with five providers in three regions will allow for a more streamlined
and stable program with more consumer choices, said ODJFS.
Other Medicaid managed care providers chosen to provide services across
the state under the new structure include Aetna Better Health of Ohio,
Meridian Health Plan, Paramount Advantage and United Healthcare
Community Plan of Ohio.
Two providers, Aetna Better Health of Ohio and Meridian Health Plan,
will be newcomers to Ohio.
“The managed care plans selected stood out among the applications and
are committed to improving health outcomes, ensuring access to care and
providing intensive case management services, especially to those
individuals with the most complex medical and social conditions,” said
John McCarthy, Ohio Medicaid director in a release.
Some current providers did not make the cut, including AMERIGROUP Ohio,
Molina Healthcare of Ohio, Buckeye Community Health Plan and WellCare
of Ohio. Those providers have a seven-day time period to protest the
decision, said Betsy Woods, CareSource spokeswoman.
The selection process is part of Ohio Medicaid’s effort to improve care
for low-income residents. New contracts with selected providers will
require managed care providers to meet more stringent standards to
receive financial incentive payments, ODJFS said.
The Dayton region will fall within the west region, which includes 34
counties on the west side of Ohio with Greene, Champaign and Clark
counties bordering the central/southeast region.
CareSource and other selected managed care providers will go through a
readiness check within the next 60 days to determine whether their
operations meet state standards, said Janet Grant, CareSource executive
director.
Ohio’s Medicaid program serves more than 2.1 million Ohioans.
Read this and other articles at Dayton Business Journal
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