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Who We Are: Amerigroup*. Amerigroup Washington, Inc. is a wholly-owned subsidiary of Amerigroup Corporation (NYST: AGP) which is headquartered in Virginia Beach, VA
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Who We Are: Amerigroup* • Amerigroup Washington, Inc. is a wholly-owned subsidiary of Amerigroup Corporation (NYST: AGP) which is headquartered in Virginia Beach, VA • Amerigroup coordinates health care services in publicly-funded health care programs – primarily Medicaid - for approximately 2.7 million members in 13 states. Kansas, our 14th state, will be added in 2013 • We focus on the health care needs of the most financially vulnerable members in the health care system – including low-income mothers and children, seniors and people with disabilities • Amerigroup Washington began serving members on July 1, 2012 as one of five Managed Care Organizations contracted with the WA Health Care Authority for the state’s Medicaid Managed Care program for Healthy Options & Basic Health *Amerigroup refers to Amerigroup Corporation and its subsidiary health plans
Who We Serve • We focus on the conditions most prevalent among the populations we serve: • Moms and kids • Seniors • People with disabilities • Accordingly, four areas are of particular interest: • Prenatal care for pregnant women to ensure healthy babies • Reduction and prevention of childhood obesity • Home- and community-based services for independent living • Diversion of members from emergency room care
Who We Serve: Our State Partners Current Markets: Florida Georgia Louisiana Maryland Nevada New Jersey New Mexico New York Ohio Tennessee Texas Virginia Washington
Amerigroup National Advisory Board Convened by Lex Frieden, a nationally known advocate for people with disabilities since the 1970s Provides expert guidance on programs to promote independent living Offers recommendations from the perspective of seniors and people with disabilities Board members from the Center for Independent Living, the President’s Committee for People with Intellectual Disabilities, AARP, the National Alliance on Mental Illness and ADAPT
Amerigroup Support Model Amerigroup Community Care 8
Amerigroup WA Service Area 41 Hospital locations 2,345 Pharmacy 2,282 PCPs/locations combined 9,669 SCPs and Ancillaries/locations combined • Legend: • Orange: Western counties awarded to AGP • Green: Eastern counties awarded to AGP
How Amerigroup works to ensure access to care for all members: Every member chooses (or is assigned if needed) a Primary Care Provider (PCP) and is then notified of that PCP by mail and by telephone Every member receives reminders to access preventive care Every member is contacted after frequent emergency department use, especially for minor conditions All pregnant women are contacted, assessed for risks and, if appropriate, enrolled in high-risk obstetrics case management Outreach programs contact new, auto-assigned members to field questions and provide the option to change their PCPs Amerigroup Health Care Management 12
Amerigroup has targeted programs to take care of members with chronic conditions and those who are most at risk for future illness Our predictive model stratifies members according to these risks: Utilization of medical resources Likelihood of inpatient admission Our variable intensity outreach to members is based on the risk severity Our approach of member-centric rather than disease-centric case management addresses primary condition(s), coexisting conditions, behavioral health and psychosocial needs We utilize a readiness-for-change approach We emphasize care and service coordination, appropriate follow-up, medication management and care transition Amerigroup Health Care Coordination 13
Our medical management program provides a coordinated approach to ensure members receive care and services at the appropriate level through individualized programs and in coordination with community services The program incorporates: Case management NCQA-accredited disease management programs (in box at right) Other disease management programs: High-risk obstetrics/neonatal intensive care unit Hypertension Obesity* Bipolar disorder* Transplant services * New programs We Focus on the Member’s Needs 14
Innovation in Delivery of Medical Care • The managed care model can: • Improve coordination of care • Promote independent living options • Utilize medical home models • Reduce emergency utilization and hospital readmissions • Coordinate care for dually eligible members • Integrate pharmacy benefits • Deliver high-quality care at a lower cost to taxpayers