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Contact (UPMC Health Plan):

Gina Pferdehirt
Director, Public Relations & Community Relations
UPMC Health Plan

UPMC for You Awarded Medicaid Agreement


PITTSBURGH (May 11, 2016) – UPMC for You announced that it has been selected to enter negotiations for a three-year agreement with the Pennsylvania Department of Human Services (DHS) to offer services to Medicaid recipients enrolled in HealthChoices in all five regions of the Commonwealth. The agreement is scheduled to begin in 2017. HealthChoices is Pennsylvania's mandatory Medicaid managed care program.

UPMC for You is the largest Medicaid plan in western Pennsylvania, with a 37.9 percent increase in membership in 2015. It provides physical health managed care benefits to more than 387,208 enrollees in 40 Pennsylvania counties in the Southwest, Northwest, and Lehigh/Capital regions.

“We are honored to have been chosen to offer services statewide. We support DHS’s efforts to move to value-based arrangements from the traditional fee-for-service payment in order to improve the health and lives of those we serve,” said John Lovelace, President of UPMC for You. “We pride ourselves on offering innovative services and solutions for members and providers as well as outstanding customer service.”

UPMC for You’s services include practice-based care managers embedded within high volume adult and pediatric provider offices, a community team that provides intensive care management in members’ homes and other community settings, maternity case managers offering pregnancy and postpartum support via telephone and face-to-face in a variety of settings, remote monitoring for congestive heart failure patients, unique programs to support transition from hospital to home, and specialized services to provide mental health support for members.

UPMC for You’s unique tools offer assistance and convenience to members. Some tools include UPMC AnywhereCare for online medical treatment from anywhere in Pennsylvania. Based on answers to an easy-to-complete questionnaire about current symptoms, a UPMC medical professional will respond with a diagnosis and recommended course of action. UPMC for You will launch a mobile app for members in the near future. The mobile app will include fingerprint ID login (for supported phones); a medical ID card; personalized listing of providers and urgent care centers; assisted dialing to the 24/7 nurse line; medical history; claims details; the ability to manage current and past prescriptions; live chat with a member services representative or health coach; secure messaging; and assisted one-touch dialing.

UPMC for You is one of four Medicaid plans in Pennsylvania to earn an overall rating of 4 out of 5 in NCQA’s Medicaid Health Insurance Plan Ratings 2015-2016. No Medicaid plan in Pennsylvania earned a higher overall rating.


About UPMC for You

UPMC for You is an integrated partner company of the UPMC Insurance Services Division, which also includes UPMC Health Plan, UPMC for Life, UPMC WorkPartners, UPMC for Kids, LifeSolutions, Askesis Development Group, eBenefits, and Community Care Behavioral Health. The UPMC Insurance Services Division offers a full range of group health insurance, Medicare, Children’s Health Insurance Program, Special Needs Plans, Medical Assistance, Commercial, behavioral health, employee assistance, benefits administration solutions, and workers’ compensation products and services to over 2.9 million members.

About NCQA

National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS is the most widely used performance measurement tool in health care. NCQA’s website (www.ncqa.org) contains information to help consumers, employers, and others make more informed health care choices.