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Managed Care Service Areas D allam Sh erm an H ansfo rd O chiltree Lipsco m b TEXAS STAR Health (statewide) – Superior CHIP RSA (MRSA Service Areas + Hidalgo) – Molina, Superior H artle y H utchin son R obe rts M o ore H em ph ill Managed Care Service Areas Po tter C arso n O ld ham G ray W heeler (Effective Fall 2016) STAR - Aetna, Amerigroup, Cook Children's STAR+PLUS - Amerigroup, Cigna-HealthSpring D eaf S m ith R and all A rm stron g D onley C olling sw o rth STAR Kids - Aetna, Cook Children's Sw ish er CHIP - Aetna, Amerigroup, Cook Children's LUBBOCK Parm er B ris coe H all C hild ress C astro DALLAS STAR - Amerigroup, FirstCare, Superior H arde m a n TARRANT STAR - Amerigroup, Molina, Parkland STAR+PLUS - Amerigroup, Superior B ailey Lam b H ale Floyd M o tley C ottle Foa rd STAR+PLUS - Molina, Superior STAR Kids - Amerigroup, Superior W ilbarger W ich ita Lam ar STAR Kids - Amerigroup, Children's Medical Center H ockley CHIP - FirstCare, Superior B aylo r C lay M o ntag ue G rays on Fan nin C och ran D icke ns K in g K nox A rche r R ed R iv er CHIP - Amerigroup, Molina, Parkland C rosb y C ook e B ow ie Lub bo ck D elta n i l Jack Titus s i W ise k r n H askell D enton r a Youn g o Yoaku m r M C ass MRSA WEST G arza K ent Sto new all Throckm o rton C ollin H opk in s F Terry Lyn n H unt C am p MRSA NORTHEAST Tarrant R ockw all R ain s M ario n W o od Scu rry Parker U psh ur STAR - Amerigroup, Superior STAR - Amerigroup, FirstCare, Superior B ord en Fisher Jon es Sh ackelford Step hen s Palo P in to G aines D aw so n D allas K aufm an Van Z and t STAR+PLUS - Cigna-HealthSpring, United STAR+PLUS - Amerigroup, Superior G reg g H arrison H ow ard H ood STAR Kids - Texas Children's, United STAR Kids - Amerigroup, Superior M artin Joh nso n Ellis Eas tlan d Sm ith A ndrew s M itchell N olan Taylo r C allah an H end erso n Era th So m ervell R usk Pan ola MRSA CENTRAL El P as o Ecto r H ill N avarro B osq ue A nde rson C hero kee Lov in g G la sscoc k C oke C om an che W in kle r Sterling R unn els Sh elb y M idland C olem an B row n STAR - Amerigroup, Scott and White, Superior Frees tone N acog do ches H am ilton M cL enn an EL PASO C orye ll Lim eston e H ous to n STAR+PLUS - Superior, United C ulbers on W ard M ills San Sab in e H uds peth C rane A ugu stine STAR Kids - Blue Cross and Blue Shield of Texas, United U pton R eagan To m G reen Leo n A nge lina STAR - El Paso First, Molina, Superior R eeves Irion C onc ho M cC u lloc h San S ab a Falls Trin ity Lam pa sas R obe rtson B ell STAR+PLUS - Amerigroup, Molina M ad iso n Tyler Jaspe r Sch le ich er M en ard W alker Po lk N ew ton STAR Kids - Amerigroup, Superior M ila m Jeff D av is Pec os B urn et JEFFERSON CHIP - El Paso First, Superior M aso n W illiam so n B razos San Llano G rim es Jacinto C rock ett B urleso n Su tton H ardin STAR - Amerigroup, Community Health Choice, Molina, K im b le Travis M o ntgo m ery G illespie Lee O ran ge B lan co W ash in gton Liberty Texas Children's, United Terrell K err Ed w ard s B astrop H ays STAR+PLUS - Amerigroup, Molina, United Pre sid io Val Verd e W aller H arris Jefferso n K end all A ustin C ald w ell STAR Kids - Texas Children's, United B rew ster R eal C om al Fayette C ham b ers B and era C olorad o CHIP - Amerigroup, Community Health Choice, Molina, G uad alupe Fort B en d G alveston G on zales Texas Children's, United M ed in a B exar Lavac a K in ney U vald e W ilson W harto n D eW itt B razoria HARRIS TRAVIS M ave ric k Jackso n K arne s M atag ord a Zavala A ta scosa Frio Vic toria STAR - Blue Cross and Blue Shield of Texas, Sendero, Seton, Superior G oliad STAR - Amerigroup, Community Health Choice, Molina, Texas Children's, United STAR+PLUS - Amerigroup, United C alh ou n STAR+PLUS - Amerigroup, Molina, United D im m it B ee R efugio STAR Kids - Blue Cross and Blue Shield of Texas, Superior La Sa lle Live O ak STAR Kids - Amerigroup,Texas Children's, United A rans as CHIP - Blue Cross and Blue Shield of Texas, Sendero, Seton, Superior M cM ullen CHIP - Amerigroup, Community Health Choice, Molina, Texas Children's, United San P atricio Jim BEXAR W ells W eb b N ueces NUECES D uval STAR - Aetna, Amerigroup, Community First, Superior K leb erg STAR - Christus, Driscoll, Superior STAR+PLUS - Amerigroup, Molina, Superior STAR+PLUS - Superior, United STAR Kids - Community First, Superior Zap ata B roo ks STAR Kids - Driscoll, Superior CHIP - Aetna, Amerigroup, Community First, Superior Jim H og g K ened y CHIP - Christus, Driscoll, Superior Starr HIDALGO W illa cy H id alg o STAR - Driscoll, Molina, Superior, United C am eron STAR+PLUS - Cigna-HealthSpring, Molina, Superior Map Prepared by: Strategic Decision Support Department, RSA: Rural Service Area STAR Kids - Driscoll, Superior, United Texas Health and Human Services Commission. MRL. MRSA: Medicaid Rural Service Area October 1, 2015 RHP3 Managed Care Service Providers • Harris & Jefferson • Amerigroup • Community Health Choice • Molina • Texas Children’s • United Healthcare • MSRA Central • Amerigroup • Cigna-HealthSpring • Scott & White • Superior • United Healthcare www.setexasrhp.com 1 HHSC MCO Contact Sheet STAR/CHIP Plan Service STAR+PLUS Plan SAs Health Plan Contact Title Email Phone Number Areas overlap with RHPs overlap with RHPs Director, Network Aetna Better Health Mary N. Downey Management [email protected] 817-477-9084 6, 9, 10 1, 2, 3, 4, 6, 8, 9, 2, 3, 6, 7, 8, 9, RVP Medicaid Provider 10, 11, 12, 13, 14, 10, 11, 12, 13, Amerigroup Catherine Mitchell Strategy [email protected] 713-218-5103 16, 17, 18, 19 14, 15, 17, 19 Blue Cross and Blue Sheild Senior Manager, of Texas April Beggs Government Relations [email protected] 512-231-7610 7, 8 Director of Network Christus Nora Medina Management [email protected] 469-282-3054 3, 4 Christian Puff Director of Compliance [email protected] 469-282-0290 Anita Leal Executive Director [email protected] 469-282-2585 Director of Preventative Community First Health Health and Disease Plans Christine Hollis Management [email protected] 210-358-6145 6 Community Health Choice Melanye Otto [email protected] 2, 3, 17 Cook Children's Health Director Network Plan Rob Robidou Development [email protected] 682-885-4485 9, 10 Driscoll Health Plan Michelle Ramirez [email protected] 361-694-6430 3, 4, 5, 6, 20 Senior Director of El Paso First Response Janel Luján, LMSW Operations [email protected] 915-298-7198 (ext 1090) 15 Director, Government FirstCare Health Plans Joe Kotlarczyk Programs, Medicaid [email protected] 512-257-6257 6, 11, 12, 13, 14, 19 Dr. Adolfo Valadez Chief Medical Officer 1, 2, 5, 6, 9, 10, Cigna-HealthSpring Maggie McDowell 18, 19, 20 Robyn Leland [email protected] 1, 2, 3, 5, 9, 10, 1, 2, 3, 5, 6, 9, Molina Healthcare John J McGuinness VP Network Management om 972-536-7232 15, 17, 18, 20 10, 17, 18, 20 also cc: [email protected] Parkland Community Health Plan Dr. Barry Lachman [email protected] 1, 9, 10, 18 Scott & White Tamara Campbell 1, 3, 4, 6, 8, 16, 17 Cindy Jorgneson [email protected] Sendero Health Plan Pamela Piatt [email protected] 512-978-8014 7, 8 Seton 7, 8 1, 2, 3, 4, 5, 6, 7, 1, 3, 4, 5, 6, 8, 9, 8, 11, 12, 13, 14, 10, 11, 12, 13, 14, Superior Health Jared Wolfe [email protected] 512-692-1465 15, 16, 17, 18, 19, 20 15, 16, 17, 18, 19, 20 Dan Crowe [email protected] Texas Children's Health Director of Government Plan Rosie Valadez Relations [email protected] 832-828-1301 2, 3, 17 Director of Quality and Rose T. Calhoun Outcomes Management [email protected] 832-828-1285 1, 2, 3, 4, 6, 7, 8, UnitedHealthcare Angela Parks [email protected] 2, 3, 5, 6, 17, 20 16, 17, 18, 19, Regional Healthcare Partnership 3 DY5 June Learning Collaborative Event MCO-DSRIP Alignment Reference: MCO Quality Initiatives PAY-FOR-QUALITY (P4Q) MEASURES HEDIS Measures W34: Well-child Visits at 3, 4, 5, & 6 yrs. (STAR, CHIP) AWC: Adolescent Well-Care Visits (STAR, CHIP) PPC: Prenatal Care and Postpartum Care (STAR only) AMM: Anti-depressant Medication Management (STAR+PLUS) CDC: HbA1c Control <8 (STAR+PLUS) PPE: Potentially Preventable Events • PPA: Potentially Preventable Hospital Admissions (STAR, CHIP, STAR+PLUS) • PPR: Potentially Preventable Hospital Re-Admissions (STAR, STAR+PLUS) • PPV: Potentially Preventable ED visits (STAR, CHIP, STAR+PLUS) • PPC: Potentially Preventable Complications (STAR, STAR+PLUS) Health plans that excel on meeting the measures are eligible for a bonus of up to 4% of their capitation rate.
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