Alabama operates a statewide “Primary Care Case Management” (PCCM) managed care program to help Medicaid recipients. PCCM’s Patient 1st Program provides a medical home. This means that patients are assigned to a Primary Medical Provider (PMP) who is responsible for providing directly or by referral necessary medical care.
Through Patient 1st, providers have access to two patient management tools that includes in-home monitoring and an electronic health record called the “QTool”, which was developed via a Medicaid transformation grant. The monitoring program enables a patient to record certain vital signs and/or test results at home and then transmit this data to a central repository to enable the PMP to monitor the patient’s condition.
Beginning May 2011, Alabama will implement an enhanced PCCM program building on the existing infrastructure. This will be accomplished by establishing regional networks within local systems of care. The plan is to achieve long-term quality, reduce costs, and improve access for Medicaid recipients.
The state will continue to operate the original PCCM program, but primary care providers in select areas of the state will now have an opportunity to become members of a regional network referred to as the “Patient Care Networks of Alabama” (PCNA). Initially, the regional networks will be in pilot counties covering 60,000 patients.
At this time, the Alabama Medicaid Agency has issued a Request for Proposal seeking respondents to establish the pilot regional networks in Area 1 (Tuscaloosa, Fayette, Pickens, Greene, Hale, Bibb), Area 2 (Lee, Chambers, Tallapoosa, Macon), and Area 3 (Limestone, Madison).
The intent of the RFP is for the contractor to provide case management services to the new networks in addition to providing existing care management. Traditional case management for the PCCM program is currently provided through a contract with the Alabama Department of Public Health (ADPH), so the contractor will also be required to provide case management services to the services provided by ADPH.
The contractor must operate as a 501(c) (3) non-profit entity with an office located in each pilot area. It is also a requirement to establish and maintain a board that represents the spectrum of network participants.
The PCNA Program will address:
• The use of information technology resources by participants and providers
• Treatment regimens for chronic illnesses to better conform to evidence-based guidelines
• Behavioral changes and self-care strategies developed in a more holistic way to plan for care
• Consumers care and see if any changes are needed for treatments
• Quality of care and how to improve health outcomes
• Reducing inappropriate use and costs associated with emergency departments and hospital inpatient services
• Population health management and how to perform systematic data analysis
The RFP (2010-PCNA-01) was issued December 1, 2010. A mandatory vendor conference will be held January 10, 2011, with the proposals due at several times. Proposals for Area 1 are due January 31, 2011, Areas 2 and 3 due by February 25, 2011.
For more information, go to www.medicaid.alabama.gov, go to Patient Care Networks of Alabama, then go to Request for Proposal for Patient Care Network of Alabama, or for other details, contact Kathy Hall, Project Director, at (334) 242-5007 or by email at Kathy.hall@medicaid.alabama.gov.
