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Network description:
Total Care’s extensive provider network includes more than 200 primary
care physicians and 1,000 specialists in three counties in Central
New York. Key providers in the network include two FQHC’s-Syracuse
Community Health Center, which is also the Plan’s provider sponsor
and Northern Oswego County Health Services. The network also includes
a faculty practice affiliated with a major University hospital,
Group practice sites and small individual practices. Ancillary services
providers are also included to provide the full range of covered
services through contracted providers
Pharmacy benefit and management:
Script Pharmacy Solutions provides pharmacy benefit management services.
TPA/Information systems:
Total Care’s Management Information System is provided through a
timeshare arrangement with The TriZetto Group. AMISYS is the main
platform.
History of the organization:
Total Care was established in 1986 under a special purpose license
issued to select providers to establish provider sponsored managed
care plans for Medicaid eligible membership. The Syracuse Community
Health Center, an FQHC and the Plan’s sponsor, provided all primary
care within the plan. The service area was the county in which the
SCHC operated.
In 1997 the plan became a Child Health Plus insurer and also expanded
into an adjoining county. The primary care network was significantly
expanded and provides wider primary care provider choice to the
membership. At that time a second FQHC in the adjoining county joined
the network.
In late 1998 and early 1999 both counties in which Total Care operates
implemented mandatory Medicaid Managed Care under the New York State
1115 waiver. The Plan grew significantly in the subsequent two years
increasing membership by over 75%.
Three major challenges the organization faces during 2001:
-Maintaining existing membership by focusing to a greater and greater
extent on outreach to the membership and hands on assistance through
the administrative processes.
-Ensuring continued growth through strategic expansion into new
geographic areas. This entails development and management of provider
networks in a wider area with differing managed care experience.
-Maintaining Total Care’s high quality of care marks and high customer
satisfaction as measured by New York State Department of Health
while also ensuring the continued delivery of cost effective health
care—all within the premium rates allowed by the payors.
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