Welcome, Gateway Health Plan. We value our relationship with you and our common goal of advancing health care and improving outcomes for all. Please enjoy exploring the latest insights and learnings from our organization which we’ve organized specifically around areas we feel may be of particular interest for you. This site will be updated over time, and I look forward to advancing the conversations about how we can partner to make health care more affordable, predictable and simple.
Gateway Health Plan: Health makes progress possible
On behalf of the entire Express Scripts team, I wanted to congratulate Gateway Health Plan on being recognized as a Medicaid HealthChoices program in the Lehigh/Capital and Southwest regions. As a trusted regulated markets partner, we would be honored to help you continue this momentum, grow your Medicaid business, and support your future endeavors.
Introducing Evernorth
Elevating health means reimagining how we partner. With open collaboration and unbiased guidance, we strive to deliver flexible, focused solutions under our new health services brand and portfolio.
The results are in
The changes we've had to navigate and the way consumers have responded to health care in the wake of COVID-19 will shape the future and health landscape as we know it. Our research yielded insights that offer an opportunity for business leaders and health care decision makers to work together to evaluate health for every member, for every plan, for all.
Health care comes home
As COVID-19 has normalized virtual health and digital care solutions in an environment where advancements in technology and consumers' demand for digital both grow seemingly at the speed of light, how can health care decision makers and health plan leaders keep up in terms of offering members the tools they need to stay healthy, in a way that is safe and fits into their day-to-day routine?
Solidifying the mind-body connection
COVID-19 has underscored the connection between physical, mental and social health. While many consumers are engaged in some sort of wellness activities, the focus on health has inspired many to take a more proactive approach to their whole well-being.
The cost-care conundrum
Keeping health care costs down remains a consistent priority for both consumers and decision makers. In fact, it's a dilemma that affects nearly every plan: How is it possible to do more with less – and still provide high quality, low cost and high touch care?
In the next decade, we are going to see health care change dramatically, and we believe technology will plan an even greater role in a person's care than ever before.
The impact of the pandemic on mental health will be long-lasting, and there is an urgent need to expand easy and timely access to care. Through Evernorth, we are delivering on a more coordinated approach to health services that will make it easier for people to get the care they need, when they need it.
Better care and better outcomes are rooted in greater choice, affordability and access, and we can bring all of these to people with the greatest needs.
Your trusted partner in regulated markets
We’re squarely focused on the quality metrics that are important to you and know that our support will help you move the needle on becoming market-leading – today and in the future. Through our clinical programs, network strategy, formulary management and levers designed specifically for regulated markets, we want to be Gateway Health Plan’s partner of choice.
Implementation and innovation success story
Hear about a real clients’ experience implementing their plan and their clients with Express Scripts.
See how we helped a client grow their Medicare business
We offer the guidance and support necessary to help our clients improve in quality outcomes and Star ratings.
Regulated markets opportunities and insights for Gateway Health Plan
We believe the key to unlocking any plan's full potential is through discovering and acting on insights that bring people and capabilities together to drive progress. Our team of regulated markets experts shared some insights and opportunities that could help improve Gateway Health Plan's market-competitiveness, compliance and growth goals. We have unique and award-winning solutions that could solve for many of the gaps we saw in HEDIS measures across three key categories: Diabetes, Asthma and Opioids.
Diabetes (HEDIS)
The bar continues to get higher when it comes to diabetes care management and blood pressure control. Today, Gateway Health Plan is scoring lower than all of your Pennsylvania health plan competitors on HbA1c and blood pressure control metrics.
Asthma (HEDIS)
Gateway Health Plan trails the Pennsylvania state average for asthma metrics and another peer Pennsylvania Medicaid health plan client of Express Scripts. Proactive management solutions and other clinical solutions could help improve critical metrics for this class.
Opioids (HEDIS)
Compared to our health plan book of business, Gateway Health Plan is scoring higher on use of opioid metrics (lower score is more desirable). We have a track record in opioid management excellence through our two-time PBM- award-winning program.
Opportunities for Gateway Health Plan exist within the Medicare market as well. While your plan saw lives growth, your member acquisition costs appear to be high, and your plan ranks 7th in MAPD behind national plans. Your local market focus combined with our national and regulated markets expertise can be a valuable combination to help Gateway Health Plan accelerate growth and achieve improved outcomes for your members.
Is the average MAPD growth rate for your service area. Lives growth is critical to achieving your results. We believe there is more room for Gateway Health Plan to grow beyond the 5.5% lives growth from 2019.
CMS cut points for the 2021 plan year are moving up by 1 to 2 points, which could cost Gateway Health Plan more than $25.3M in quality bonus payments (QBR). We can help your plan avoid this cost by improving adherence metrics and improving market-competitiveness to stabilize the population and grow.
Health Connect 360 is the common thread solution for Gateway Health Plan
Health Connect 360 is the industry's first outcomes-based model of care that guarantees clinical targets and connects patient touch-points across the care continuum. Watch the video below to learn more.
2019 Health Connect 360 pilot results
The 2019 Health Connect 360 results over-performed, even for clients who previously had many of our individual stand-alone programs. All clients who participated continued to implement Health Connect 360 in 2020.
A simpler patient experience: Meet Tommy
As members demand more personalized health care and your plan seeks new ways to get more value for the money you spend, Express Scripts delivers a new clinical management model combining personalized care plans to each individual, high-touch clinical expertise and actionable data insights.
Actionable insights
Connecting pharmacy, medical, lab and member engagement data daily, through our Care Insights Hub, allows us to identify more relevant, actionable gaps-in-care or health opportunities and act on them faster. For each patient, clinical care support will be tailored to specific engagement preferences.
Supporting your members where they need it most
Health care needs are as individualized as the members who make up your population. As an Accredo client, your members with complex conditions are in good hands. Our service model includes individual centers of focused expertise, dedicated to serving them. Hear more from Brian Seiz, Senior Vice President of Specialty, on how we approach specialty differently.
Integrating for seamless care and optimized savings
Oncology is the third most costly therapy class across commercial plans. As plans everywhere grapple with the task of managing oncology therapeutic spend and supporting their cancer patients, there is significant evidence that an integrated medical and pharmacy approach yields improved outcomes, in oncology, and across most therapeutic classes – especially for those with complex conditions.
As a trusted health services partner, we’re aligned in the battle with carve-out, and ensuring you have the best ammunition to tell your carve-in story and keep your edge.
As a trusted health services partner, we’re aligned in the battle with carve-out, and ensuring you have the best ammunition to tell your carve-in story and keep your edge.
lower oncology in-patient costs1
lower overall spend when pharmacy and medical are integrated vs. carved out
Aligned with Gateway Health Plan, we'll deliver world-class health services with a singular focus: to make health care more affordable, predictable and simple.
Affordable
We build on our leading, differentiated position to lower the total cost of care
Predictable
We take surprise out of the system and help people make informed health care choices
Simple
We make it easier for the people we serve to get the care they need
References:
1. Cigna 4th Annual Value of Integration Report: https://www.cigna.com/newsroom/news-releases/2020/combining-medical-pharmacy-and-behavioral-benefits-delivers-annual-savings-of-more-than-850-per-customer-with-an-identified-opportunity
1. Cigna 4th Annual Value of Integration Report: https://www.cigna.com/newsroom/news-releases/2020/combining-medical-pharmacy-and-behavioral-benefits-delivers-annual-savings-of-more-than-850-per-customer-with-an-identified-opportunity