In 2006, the Legislature directed the Health and Human Services Commission to utilize cost-effective models to enhance the care of Medicaid recipients who are aged, blind, or have disabilities. As part of that initiative, the state created the Integrated Care Management program, which integrates acute and long-term care services and support through a fee-based coordinated care program.

HHSC has selected Evercare of Texas to provide healthcare coordination services for more than 80,000 people enrolled in the ICM program in the Dallas and Tarrant county service delivery areas. When the ICM program is implemented, it will serve 13 counties: Collin, Dallas, Denton, Ellis, Hood, Hunt, Johnson, Kaufman, Navarro, Parker, Rockwell, Tarrant, and Wise.

“We’re pleased that the State has recognized our 20 years of experience in coordinating care and understanding the unique health and wellness needs of people who are aged, blind, or have disabilities,” said John Mach, CEO of Evercare. “Through our relationships with healthcare and social service providers, sophisticated technology, and our proven care model, Evercare can integrate the full spectrum of services necessary to meet the needs and goals of the people served by the ICM program.”

Key components of the Evercare model include the use of service coordinators, consumer advocates, community groups and providers, in-home services, as well as evidence-based medicine and electronic health records in all aspects of planning and delivery of coordinated care. The model applies an individualized approach to care that can improve access to complex care delivery systems, stabilize or delay progression of illnesses or chronic conditions, and promote self-care and independence for people served by the ICM program.

“Our expertise in managing clinical and non-clinical quality improvement activities and managing utilization is designed to exceed quality benchmarks and help our members receive the right services, at the right time, in the right settings,” Mach said.

Evercare offers a network of medical providers with the capacity to provide timely access to regular and preventive care. It also offers an integrated network of community-based medical, behavioral health, and social care providers that spans the continuum of care services.

To prevent barriers to medical care, Evercare regularly analyzes its provider network to help members obtain timely and convenient access to service. Evercare also continually compares the linguistic and cultural needs of its membership with their provider network, and takes action as necessary.

Evercare will utilize an Electronic Health Information system that will give providers access to ICM member information, including the service coordination plan, disease management information, and other care planning information.

Evercare has direct experience working with individuals who are blind, aged, or have disabilities and who qualify for both Medicaid and Medicare. Evercare of Texas has been involved with the STAR+PLUS program since its inception in 1997, serving the needs of approximately 34,000 STAR+PLUS enrollees. Evercare also serves more than 10,000 Texans through a Medicare Special Needs Plan.

“Our roots in Texas run deep,” said John Weymer, executive director for Evercare of Texas in Dallas and Fort Worth. “Evercare has extensive experience in improving the health outcomes and restoring greater functional independence for Texas Medicaid recipients, and we look forward to building on our record of providing coordinated care that has resulted in reduced healthcare costs while earning high satisfaction ratings from the people we serve.”