title: The Philadelphia Health Insurance Organization: the results of managed health care for 96,000 medical assistance recipients.
abstract: 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.
mesh_terms: 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