Evercare of Texas, a subsidiary of UnitedHealth Group, was selected by the Texas Health and Human Services Commission (HHSC) to serve as the sole provider of health care coordination services for more than 70,000 people who are aged, blind or have disabilities and are enrolled in the HHSC’s new Integrated Care Management (ICM) program.

Evercare’s proven service coordination model facilitates improved health and social outcomes for members of the ICM program, resulting in reduced costs to the state.

About the ICM Program
In 2006, the Texas Legislature enacted legislation directing the Texas HHSC to utilize alternative, cost-effective models to better manage the care of people who are aged, blind, or have disabilities, and are enrolled in Medicaid.

In response, the ICM program integrates acute and long-term care services and support through a fee-based coordinated care program for individuals enrolled in Medicaid. The program was designed collaboratively with and sponsored by Dallas-Fort Worth-area physicians, hospitals, other healthcare providers, the “ICM Advisory Committee” and the state legislature. Enrollment in the ICM program includes all adult Medicaid Supplemental Security Income (SSI) members and is voluntary for SSI children under the age of 21 receiving Medicaid benefits.

The ICM program will be available in 13 counties in Texas including Collin, Dallas, Denton, Ellis, Hood, Hunt, Johnson, Kaufman, Navarro, Parker, Rockwell, Tarrant, and Wise.

The Evercare Service Coordination Model
The Evercare model applies a personalized, whole-person approach to care. Evercare’s expertise in managing clinical and non-clinical quality improvement activities and managing utilization is designed to exceed quality benchmarks and ensure Evercare members receive the right services, at the right time in the right settings. Evercare also works with providers and members to promote wellness and allow members to remain in their homes as long as possible rather than moving immediately to a nursing home through effective utilization of home and community-based services.

Key components of the Evercare service model include the use of nurses and service coordinators, consumer advocates, community groups and providers, as well as evidence-based medicine, in-home services, and electronic clinical information systems. Other features of the ICM program include: chronic illness management, an authentication pilot program with agencies that provide in home services to reduce fraud and abuse, in-home physician services, and on-site care coordinators in high volume hospitals to help facilitate appropriate discharge to the community.

Evercare’s Network of Care Providers
Evercare of Texas offers an integrated network of community-based medical, behavioral health, social and Long-Term Services and Support (LTSS) care providers, who span the continuum of care services and are necessary to effectively meet the needs of members of the ICM program.

The Evercare network of medical providers comprises primary care physicians, pediatric, specialty providers, inpatient and ancillary provider networks and behavioral health providers with capacity to provide timely access to acute and preventive care. Contracted hospital systems include: Parkland, Texas Health Resources (THR), HCA, Methodist, Children’s Medical Center, John Peter Smith (JPS), Cook Children’s, and Baylor.

To reduce barriers to medical care, Evercare systematically analyzes the network of providers to help ensure members have timely and convenient access to services. Evercare also continually evaluates the linguistic and cultural needs of our membership to help ensure the provider network and other aspects of our offering are appropriately tailored.

Contracting Considerations
This program began February 1, 2008 for members receiving LTSS services, and March 1, 2008 for other members Providers must be contracted with Evercare to continue to see these patients. A “grace period” through May 31, 2008 will allow all current non contracted Medicaid SSI providers to care for members participating with Evercare ICM. For more information about joining the Evercare ICM provider network, call Evercare Provider Relations at 972-866-1696.

Also, physicians can come into the ICM program and participate as either “open” panel, “existing patients only” panel or if coming in as a part of a group as “closed” panel provider with limited coverage.

Evercare’s Experience
Evercare of Texas brings in-depth knowledge to the ICM program. Evercare has a 20-year history of working with people who have long-term or advanced illness, are older, or have disabilities and qualify both for Medicaid and Medicare.

Evercare currently operates seven integrated service coordination programs in six states that serve more than 70,000 members, with two additional programs currently in the implementation phase.
Additionally, Evercare of Texas has been part of the STAR+PLUS program since its inception in 1997, effectively serving the needs of approximately 54,000 STAR+PLUS members. Evercare also serves more than 10,000 Texans through its Medicare Special Needs Plans.

About Evercare
Evercare is one of the nation’s largest health care coordination programs for people who have long-term or advanced illness, are older or have disabilities. Founded in 1987, Evercare today serves more than 150,000 people nationwide through Medicare, Medicaid and private-pay health plans, programs and services—from health plans for people in community and skilled nursing settings, to caregiver support and hospice care. Evercare offerings are designed to enhance health and independence, and in the complex world of health care, make getting care easier. Evercare is part of Ovations, a division of UnitedHealth Group (NYSE: UNH) dedicated to the health care needs of Americans over age 50.

Company website: EvercareHealthPlans.com
Media Contact: Kathleen Harrington, (952) 936-6946