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Health Plan Awarded Grant to Improve Quality of Care for Diverse Population

PITTSBURGH (November 10, 2004) UPMC Health Plan is one of 12 health plans in the country to be awarded a grant from the Center for Health Care Strategies (CHCS) to help improve the quality of care for racially and ethnically diverse people on Medical Assistance.

Specifically, the Health Plan will focus on improving the quality of health care for pregnant women who are enrolled in the Health Plan's Medical Assistance program, called UPMC for You.

The Medical Assistance program covers a disproportionate number of racially and ethnically diverse people. As a result, state Medical Assistance purchasers and their managed care contractors are uniquely situated to generate improvements in the quality of care and health outcomes for millions of racially and ethnically diverse beneficiaries.

CHCS sent a request for proposal to the Health Plan, and the Health Plan responded with a way to improve the quality of care for pregnant UPMC for You members who live within the primary service area of UPMC Braddock Hospital.

Eligible women will be assigned a "health coach," who, through phone calls and home visits, will keep the member involved in maintaining her health during pregnancy. The health coach is essential in helping the pregnant woman find community resources that will help her achieve a healthy pregnancy. Health coaches will work closely with Community Care Behavioral Health, which is UPMC Health Plan's behavioral health managed care organization. If a woman has a behavioral health need that has not been addressed, the health coach will contact Community Care on the woman's behalf. This step will prompt follow-up contact by Community Care. This family case management model is based on the philosophy that care is a partnership between the family and the professionals who provide care and services.

The main focuses of the program are early and consistent prenatal care, smoking cessation, drug and alcohol treatment, domestic violence screening, and postpartum care. When appropriate, members will be referred to behavioral health services, agencies within the Braddock community, UPMC smoking cessation programs, and the high-risk prenatal clinic at Magee-Womens Hospital.

The goals of the program include an increased rate of member identification in the first trimester of pregnancy, an increased rate of prenatal care in the first trimester and regularly until delivery, and an increased number of full-term babies. The success of the program will be measured by infant birth weight, infant gestational age at delivery, infant mortality rate, smoking cessation rate, drug and alcohol care rate, timeliness of prenatal care rates and postpartum care rates.

CHCS awarded the Health Plan $10,000 for the program, which will help defray data collection and analysis and travel costs. The Health Plan has the full support of the Department of Public Welfare for this initiative.

Since 1995, the Center for Health Care Strategies (CHCS) has striven to continuously improve the quality of health and health-related services for beneficiaries of our nation's health coverage safety netMedical Assistance and the State Children's Health Insurance Program.

UPMC for You is UPMC Health Plan's Medical Assistance product, approved by the Department of Public Welfare to provide care for people receiving Medical Assistance. UPMC for You offers health insurance, healthy-living education, and preventive services to an increasing number of people in 18 Pennsylvania counties. Because UPMC for You is part of UPMC Health Plan, members can receive care from some of the finest doctors in the area. More than 4,500 doctors and 60 hospitals participate in the UPMC for You network.

UPMC Health Plan is a subsidiary of the University of Pittsburgh Medical Center (UPMC).

Community Care Behavioral Health is owned by UPMC and is a sister company to UPMC Health Plan. It was founded in 1996, and now has a contracted network of more than 1,000 providers throughout western, central, and eastern Pennsylvania. Community Care serves commercial and Medicare members in Allegheny County and other areas served by UPMC Health Plan and Medical Assistance members in Adams, Allegheny, Berks, Chester, and York counties. For more information on Community Care, visit its website at www.ccbh.com.

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