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Ohio rates CareSource as ‘excellent’ in 2004
Medicaid HMO meets or exceeds state performance measures
DAYTON, Ohio, January 3, 2005 – CareSource, Ohio’s largest Medicaid managed health care plan, has achieved an a performance rating of “excellent” for 2004 from the Ohio Department of Job and Family Services (ODJFS). The rating refers to CareSource’s performance on certain measures that ODJFS uses to evaluate the effectiveness of Medicaid managed care plans in the state. The results were released Dec. 6.
“Achieving the rating could not have happened without the strong partnership between our network of health care providers and all departments and employees at CareSource,” CareSource President and CEO Pamela Morris said. “Our dedicated employees continually look out for our members’ best interests and take their health and well-being to heart.”
ODJFS has established a performance incentive system for Medicaid health plans to improve care in specific areas important to members. Incentives consist of an “at-risk” monetary amount included in monthly premium payments from the state, as well as possible additional monetary awards. The criteria used to measure the performance of Medicaid plans include quality and clinical performance measures, consumer satisfaction, appropriate administrative practices, case management rates, member access to primary care, and primary care provider turnover rates.
To achieve the rating of excellent, CareSource met or surpassed benchmarks on all six of the state’s minimum performance measures (External Quality Review, PCP Turnover, Child and Adult Access to Care, Emergency Department Diversion, and Consumer Satisfaction); eight clinical performance measures (Prenatal and Postpartum Visits, Initiation of Prenatal Care, Well-Child Exams for three age groups, Appropriate Use of Asthma Medication, and Annual Dental Visits); and three incentive measures (Case Management of Children, Adult Access to Preventive Care, and Appropriate Use of Asthma Medication).
About CareSource
Established in 1989, CareSource serves almost 350,000 Medicaid consumers in 13 counties in northeast, central and southwestern Ohio. CareSource covers all Medicaid services required by the Ohio Department of Job and Family Services and offers extra benefits such as a 24-hour nurse hotline, a gift certificate program for pregnant members and transportation to medical appointments.
CareSource is affiliated with CareSource Management Group, which offers a full spectrum of services for companies that operate a managed health care plan. Among CSMG’s services are administration, including claims processing and payment, case and medical management, provider relations, quality improvement, and regulatory compliance; 24-hour services, including a nurse hotline; and financial consultation and turnaround. CSMG administers Community Choice Michigan, a Medicaid managed-care plan serving 48,000 members in 38 counties in Michigan.
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