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·4 min read

Highmark Wholecare, formerly Gateway Health, has been a leading managed care organization for 30 years

PITTSBURGH, Aug. 31, 2022 /PRNewswire/ -- Highmark Wholecare, formerly Gateway Health, has been selected by the Pennsylvania Department of Human Services (DHS) as a Medicaid managed care organization (MCO) through the 2019 Pennsylvania HealthChoices Physical Health request for applications (RFA) process. The 2019 HealthChoices Physical Health RFA results will be implemented on Sept. 1, 2022.

Highmark Wholecare Blue Shield logo (PRNewsfoto/Highmark Wholecare)
Highmark Wholecare Blue Shield logo (PRNewsfoto/Highmark Wholecare)

Established in 1992, Highmark Wholecare is a leading mission-driven, member-centric managed care organization dedicated to caring for the total health of its members. Through its robust Medicaid and Medicare programs – and in collaboration with a network of 29,000 primary care physicians, specialists, hospitals, community partners and other ancillary providers – Highmark Wholecare coordinates health care that goes beyond doctors and medicine that helps members achieve whole life health.

In 2021, Highmark Wholecare's Medicaid plan in Pennsylvania achieved a Medicaid Accreditation score of 4.0 (out of 5 stars) from the National Committee for Quality Assurance (NCQA). Highmark Wholecare Medicare Advantage dual-eligible special needs plans (D-SNPs) earned a 4.5-star quality rating (out of five stars) for contract year 2022 from the Centers for Medicare and Medicaid Services (CMS).

"At Highmark Wholecare, our mission is to care for the whole person in communities where the need is greatest, and we see a future where everyone has an equal opportunity to achieve their best health," said Ellen Duffield, President and Chief Executive Officer, Highmark Wholecare. "We are proud that the state entrusts us to care for vulnerable families and communities. Our corporate headquarters are in Pittsburgh and our membership resides exclusively in Pennsylvania. The majority of our associates live and work in the state. Our members are our neighbors."

Along with its extensive provider network, Highmark Wholecare's care model includes coordinating with a wide range of community partners to help address members' social determinants of health (SDoH) needs. Social determinants of health are the conditions in which people are born, grow, live, work and age. Up to 80% of a person's health is determined by these factors, which can include lack of access to quality food, housing, education, jobs and transportation.

"We pride ourselves on being a community-based health plan, supporting not only our members, but organizations within the communities we serve that provide the types of resources and assistance that our members need," Duffield said. "We are proud to help local businesses and non-profits in pursuit of providing our members with the best care possible so they can live healthier lives and achieve not just physical health, but whole life health."

Highmark Wholecare has prepared for the HealthChoices implementation by executing a stringent internal review of the nearly 2,000 readiness items requested by DHS prior to implementation.

"For nearly a year, we have been preparing diligently for the HealthChoices implementation to ensure there is no disruption of care for any of our members," Duffield added. "We identified and empowered a dedicated readiness team that has followed the guidance set forth by DHS. The process has proceeded so smoothly that by the end of 2021 we had addressed 99% of the readiness items requested by DHS."

In 2021, Highmark Health acquired full ownership of Gateway Health, after previously holding a 50% ownership interest. Gateway Health was established in 1992 through a partnership that included Highmark Health and Mercy Health.

Highmark Health acquiring sole ownership paved the way for Gateway Health to become a Blue Cross Blue Shield licensee. Highmark Wholecare Blue Cross and/or Blue Shield Medicaid and Medicare Advantage D-SNP health plans became available across Pennsylvania on Jan. 1, 2022.

About Highmark Wholecare

We believe in caring for the whole person in all communities where the need is greatest. We see a future in which everyone has equal opportunity to achieve their best health. Through our leading Medicaid and Medicare programs, we are coordinating healthcare that goes beyond doctors and medicine that helps members achieve not just physical health, but also delivers whole person care. Our associates are helping to drive this new kind of healthcare for our 370,000 Medicaid and Medicare members in collaboration with a network of 29,000 primary care physicians, specialists, hospitals, and other ancillary providers. We are also committed to supporting our neighbors through our many community outreach and engagement programs.


View original content to download multimedia:https://www.prnewswire.com/news-releases/highmark-wholecare-selected-by-pennsylvania-to-care-for-states-most-vulnerable-citizens-301615819.html

SOURCE Highmark Wholecare