1. Jay Feldstein, DO, CMO AmeriHealth Mercy/Keystone Mercy Health Plan
Medicaid and The PCS
Jay Feldstein, DO, CMO
AmeriHealth Mercy/Keystone Mercy Health Plan

2. Company Overview
AmeriHealth Mercy and our affiliates comprise the largest family of Medicaid managed care plans in the United States, touching the lives of nearly 5 million members in 16 states.
AmeriHealth Mercy is the nation’s expert and industry leader in providing managed care services and management for Medicaid and State Children’s Health Insurance Program populations.

3. Mission and Values Mission Values Advocacy Care of the Poor Compassion
We help people:
Get care
Stay Well
Build healthy communities
We have a special concern for those who are poor.
Values
Advocacy
Care of the Poor
Compassion
Competence
Dignity
Diversity
Hospitality
Stewardship

4. Who We Are Mission-driven, provider-affiliated
Largest Medicaid-only, multi-state plan with over 20 years of experience
Five distinct product lines:
Full risk health plans
Management and administrative service contracts
PerformRx pharmacy management
PerforMED care management
Behavioral Health

5. The AmeriHealth Mercy Family of Companies

6. Keystone Mercy Health Plan Pennsylvania

7. THE FACTS 300,000 MEMBERS 200,000 ER VISITS / YEAR
$37 MILLION ER COSTS / YEAR
20 HOSPITALS

8. ER DIAGNOSIS ASTHMA CHEST PAIN FEVER, URI CHF MUSCULOSKELETAL
ABDOMINAL PAIN

9. ER ISSUES 50% ADMITS THROUGH ER FREQUENT FLIERS MULTIPLE VISITS
MULTIPLE ER’S

10. PATIENT POPULATION MULTIPLE CO-MORBIDITIES MULTIPLE MEDICATIONS
MULTIPLE PHYSICIANS
POOR HISTORIANS

11. CASE EXAMPLE 50 y.o. B/M, Diagnoses CAD, DM, HTN HOMELESS
68 ADMISSIONS
10 CARDIAC CATHERIZATIONS

12. PCS MEDICAL RECORD AT POC CLINICAL HISTORY MEDICATIONS
DIAGNOSTIC TESTING
THERAPEUTIC GAPS

13. OUTCOMES REDUCE DUPLICATION OF DIAGNOSTIC SERVICES
APPROPRIATE MEDICATION THERAPY
REDUCE ADMISSIONS
REDUCE ER AND IP COSTS

14. Results
1000 RECORDS
MOST COMMON DIAGNOSES
Coma
Chest Pain
FINANCIAL