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Contact (UPMC Health Plan):

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

UPMC for You Selected by the Commonwealth of Pennsylvania for
Community HealthChoices Managed Care Agreement


PITTSBURGH (August 30, 2016) – UPMC for You announced that it has been selected to enter negotiations for a multi-year agreement with the Pennsylvania Department of Human Services (DHS) to offer services to more than 400,000 people statewide who are dually eligible for Medicare and Medicaid or receive Medicaid funded long-term services and supports (LTSS). LTSS include both long-term care in a nursing facility as well as community-based alternatives for older adults and people with disabilities. The program is scheduled to begin in July 2017 in Southwestern Pennsylvania, in Southeastern Pennsylvania in 2018 and statewide by 2019.

This new program, Community HealthChoices (CHC), will coordinate physical health care and LTSS to enhance the quality of life and independence for frail seniors and adults with disabilities in the least restrictive setting. Selected plans will be required to offer Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) to further enhance coordinated care for participants choosing the same plan for their Medicare and Medicaid coverage. UPMC for Life Dual, UPMC for You’ s D-SNP, serves 21,630 people in 28 counties across western Pennsylvania. UPMC for Life Dual is the largest stand-alone 4-Star D-SNP in the nation.

Also, 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 396,471 enrollees in 40 Pennsylvania counties in the Southwest, Northwest, and Lehigh/Capital regions. UPMC for You is also a top-rated Medicaid plan in Pennsylvania, with a rating of 4 out of 5 in NCQA’s Medicaid Health Insurance Plan Ratings 2016–2017.

“We are honored to have been chosen to offer these important services to help people remain independent in the communities they choose,” said John Lovelace, President of UPMC for You. “We applaud and support DHS’s efforts to move to this best practice and are happy to have the opportunity to offer the best services and assistance for members through our outstanding customer service.” He adds, “UPMC for You has a strong and proven track record serving dual eligibles. CHC offers us the tools to further advance quality and innovation statewide and improve health outcomes and quality of life.”

In addition to the quality of services for dual eligibles, UPMC for You’s plan is built on the foundation of UPMC’s integrated delivery system which includes providers across the continuum of care. Additionally, UPMC for You’s proposal embraces its roots in Pennsylvania and is building its CHC model of care on local collaborations.


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, Askēsis 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.