Care services merge

PARKERSBURG – The West Virginia Family Health Plan is collaborating with Highmark Blue Cross Blue Shield West Virginia in a new venture to provide managed care services in West Virginia and for Medicaid recipients, officials said on Tuesday. The Family Health Plan received a certificate of authority from the West Virginia insurance commissioner on Feb. 11 to operate as a provider sponsored network and is seeking approval from the state Department of Health and Human Resources Bureau of Medical Services to operate as a Medicaid managed care organization.

The collaboration between Family Health Plan and Highmark West Virginia was made possible under the provisions of House Bill 4438 passed during the 2012 legislative session. Family Health Plan will operate a provider sponsored network, which is owned and governed by 26 shareholders, including 22 federally qualified health centers and community health centers from around the state, two other clinics, the West Virginia Primary Care Association and Highmark West Virginia.

“Given the new federal health reform legislation and the ever-increasing focus on the costs of Medicaid, it was visionary for the West Virginia Legislature and Gov. (Earl Ray) Tomblin to create a new approach to delivering care that takes advantage of the unique abilities of community-based providers throughout the state,” said Fred Earley, president of Highmark Blue Cross Blue Shield West Virginia.

“We are very pleased to be a part of this innovative approach to bringing a new care model to our state’s Medicaid population.”

The Family Health Plan will operate as an independent company with the health centers holding majority control.

Family Health Plan expects to begin full operations in the third quarter once approval from the Bureau of Medical Services has been received. Efforts are under way to have staff and resources in place and organized once Family Health Plan is accepted as a Medicaid managed care organization.

“Our collaboration with Highmark will allow the (health centers) and clinics to serve the Medicaid population as part of an integrated managed care system for the first time,” said Steve Shattls, executive director and CEO of Valley Health Systems Inc.

Working with Highmark West Virginia and its provider network, the health centers will build a new care delivery model and bring a more cost-effective approach to Medicaid managed care while also enhancing quality and health outcomes, he said.

Highmark serves 300,000 customers through the company’s health care benefits business and also serves tens of thousands of additional members through the Blue Card program.

Community health centers serve more than 379,000 West Virginians, providing health care services such as primary care, obstetrics, behavioral health, dental and pharmacy.