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Alabama Community Care Approved by Medicaid as Regional Care Organization in Alabama

12/18/2014

State Medicaid officials have granted approval to Alabama Community Care to provide Medicaid managed care services for nearly 200,000 enrollees in north and west central Alabama. The goal of the new health care delivery model is to improve community health by creating medical homes for Medicaid enrollees and engaging the medical community as providers. Alabama Community Care will also support the Alabama Medicaid Agency’s goals to transform care delivery, expand access, improve outcomes and address provider reimbursement.

Alabama Community Care is a not-for-profit regional care organization (RCO) established earlier this year to meet the Alabama Medicaid Agency’s plan to transform how services are provided to Medicaid recipients, and is a partnership among Huntsville Health System, DCH Health System, Whatley Health Services, Indian Rivers Community Health Center, Greater Alabama Health Networks and Virginia-based Sentara Healthcare.

With this announcement, Alabama Community Care will work with area physicians, hospitals and other providers to establish medical homes and care coordination programs for all medical and behavioral care services in Region A, which includes about 120,000 patients and 10 counties across North Alabama, and Region C, which includes 65,000 patients and 13 counties in West Alabama.

“We are excited about the opportunity to work with the physicians in our communities and with our Medicaid provider partners throughout Region A and Region C,” said David Spillers, CEO of Huntsville Hospital Health System. “This approval from the state is an important step in the development of a new delivery model for Medicaid in Alabama.”

Spillers said the partnership with Sentara is a huge advantage for Alabama Community Care. “Sentara brings nearly 20 years of experience in providing managed care services to 170,000 Medicaid enrollees in Virginia. They are a large diverse health system with a similar mission to ours and they have a long successful track record in serving Medicaid patients,” he said.

Michael M. Dudley, President and CEO of Sentara Health Plans, said, “Today is a momentous occasion for Alabama Community Care. It is a step toward a future of better health for the community.  We envision a strong partnership between doctors, hospitals and the health plan that provides Medicaid beneficiaries with greater access to quality, affordable healthcare.  If we succeed, patients will be healthier, the community will be stronger, the state will be assured and the providers of care will be fulfilled.”

DCH Health System CEO Bryan Kindred said the partners in West Alabama were among the area’s leading health care providers. “I am pleased that our Region C partners have a long history of providing excellent patient care. We are embarking on a new plan for delivering service to Medicaid patients, and I feel very good about the team we have in place.”

The Alabama Legislature approved the RCO delivery approach for Medicaid in 2013, mandating that all RCOs become operational by October 2016 in five regions in the state.  The new system will move Medicaid from the traditional “fee-for-service” model to a managed care approach in which the state will pay the RCO a set amount for each beneficiary’s healthcare services.

Alabama Community Care, Inc. is a not-for-profit Regional Care Organization that will serve Medicaid enrollees in two regions of Alabama. In Region A, 10 counties of North Alabama, Huntsville Hospital Health System has partnered with Sentara Healthcare of Virginia. In Region C, 13 counties of West Alabama, Huntsville and Sentara have partnered with DCH Health System, Whatley Health Services, Indian Rivers Community Mental Health Center and the Greater Alabama Health Network. In both regions, Alabama Community Care intends to work with local physicians, hospitals and other health care providers to improve the health of Medicaid enrollees. Huntsville Hospital Health System serves patients across Northern Alabama through its team of 12,000 employees working in nine affiliate hospitals and other facilities. The Sentara Healthcare family is a diverse health system with an award-winning health plan, Sentara Health Plans that has over 19 years of experience in Medicaid managed care. The DCH Health System, based in Tuscaloosa, Ala., operates DCH Regional Medical Center and Northport Medical Center and manages Fayette Medical Center. Alabama Community Care will be responsible for all aspects of care for Medicaid patients, including chronic illnesses, customized wellness programs, integrated clinical and behavioral health services and pharmacy management. To learn more about Alabama Community Care, please visit www.alabamacommunitycare.org.





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