The Philadelphia Health Insurance Organization: the results of managed health care for 96,000 medical assistance recipients.
On March 1, 1986, an innovative Medicaid program serving 96,000 recipients began operation in Philadelphia, Pennsylvania. Known as the HealthPASS program, it changed the previous fee for service Medicaid program into a capitated, managed care "gatekeeper" system. The plan was administered through a Health Insurance Organization (HIO) designed cooperatively by the Pennsylvania Department of Welfare and a for-profit health maintenance organization. In its first year, the program enrolled over 500 physician case managers, saved the Commonwealth of Pennsylvania $20 million, instituted a quality assurance program with on-site audit of primary care physician office facilities and medical records, provided a 24-hour hotline, made available central case management for mental health care, and began to compile a comprehensive database to support medical case management.
D003363:Cost Control / Q000379:methods; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D010414:Pennsylvania; D015143:Philadelphia; D010865:Pilot Projects; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D013219:State Government; D014600:Utilization Review / Q000706:statistics & numerical data