Gateway Health Plan: Health makes progress possible

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.
little boy at clinic
Rachel Reese
Rachel Reese
Vice President, Sales
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.
COVID-19 has challenged our health care system like no other. But we're always looking ahead, identifying ways to redefine what's possible. We polled consumers and plan sponsors across the U.S. to assess the state of health care in the years ahead.

Health Care in Focus
Glen Stettin
Glen Stettin, MD
Chief Innovation Officer, Evernorth
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.
Eva Borden
Eva Borden
Vice President, Behavioral Health, Evernorth
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.
Dr. Wig
John Wigneswaran, MD
Chief Medical Officer, Evernorth
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.

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.
6.75% 6.75%
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.
$25M $25M
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.

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.
24% 24%
lower oncology in-patient costs1
10% 10%
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.

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Affordable
We build on our leading, differentiated position to lower the total cost of care
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Predictable
We take surprise out of the system and help people make informed health care choices
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Simple
We make it easier for the people we serve to get the care they need
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We’re committed to helping health plans grow. I look forward to continuing the conversation about how we can help Gateway Health Plan. Please reach out to me if you have any questions.
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