Trusted Health Plan is seeking a launching pad into the Pennsylvania market as it bids against larger Medicaid managed-care rivals to provide services in the state’s southeastern region.
The company has submitted a proposal to be a Medicaid managed-care provider with the Pennsylvania Department of Human Services, competing against such competitors as Aetna, Gateway Health Plan, United Healthcare and AmeriHealth for the contract.
If THP wins, company officials plan to launch health and wellness centers in the region, including three in Philadelphia.
“We believe that Pennsylvania is the perfect place for us to expand our business model, where we focus on delivering a high touch health care model for our members,” said Thomas Duncan, CEO of the African-American-owned company based in Washington, D.C.
Trusted Health Plan, which was launched in July 2013, currently serves more than 30,000 Medicaid members in Washington. The company has built two health and wellness centers in that area where its members have access to on-site case management and care coordination.
“We spend a lot of time identifying members that can best served by having by what we consider high touch engagement, that means having our nurse case manager working with those members more rigorously than others,” Duncan explained.
The case managers work with members who have a high number of emergency room or in-patient visits to help them navigate the health care system. About 20 percent of its membership utilize the centers every year, according to THP.
When THP launched its first health and wellness center in 2014, Duncan said it began to see positive results among members, who benefited from an assessment regarding emergency room visits. He said after the group of members started visiting his company’s centers, emergency visits went down significantly for the group.
“Our model is we actually employ our people in the states that we operate,” said Duncan, who is a Detroit native. “We build our health and wellness centers where we operate and we hire in the communities that we serve.
“I think that it’s because of the fact that we are minority led, that we are comfortable investing in those communities and setting up operations and hiring in the communities we serve,” he added.
Duncan is no stranger to the health care industry. The Florida A & M University graduate started in the field at a small community-based hospital in Detroit and later established Care Compensation Specialists, which did Medicaid enrollment for hospitals.
Duncan subsequently sold CCS in 2007 for stock options to Accretive Health. When Accretive Health went public on the New York Stock Exchange, Duncan invested his revenues into starting Trusted Health Plan.
Earlier this year, three new investors joined Trusted Health Plan’s team.
One of them is Thomas Scully, the former head of the Centers for Medicare and Medicaid Services. He serves as the board of directors’ chairman.
Robert Haft, managing partner of Morgan Noble Healthcare Partners, joined the company and serves as a director. The last is Juggernaut Capital Partners, a Maryland-based investment firm with more than $600 million of capital under management.
Bishop J. Darrell Robinson of Yesha Ministries said that THP deserves a chance to serve as Medicaid managed-care provider in the region.
“I had the opportunity to meet with the owners and the principal people and they are the first group to who talked about not just bringing a program to different groups here and there but coming into the community and becoming a stakeholder and for me as a pastor I look forward to that,” Robinson said.
He said the company has pledged to work with the faith-based and community organizations.
“The fact that they really want to come in and really morph with the community is what moves me,” Robinson said. “They understand the needs of the community and on top of that they are going to hire people from within the community. They want to come into the community and be a part of the community.”
Jermaine Bromell, founder and CEO of the Better Health Network, also welcomes the possibility of THP coming to the region.
The BHN is a community-based health support company that helps with insurance enrollment, linkage to primary care physicians and strategies to reduce unnecessary medical care utilization.
“We’ve been collaborating with faith-based organizations around how health care is changing and how we can address some of the gaps in the system, particularly for our community,” Bromell said. “Trusted gives us the opportunity to collaborate with a company that is really focused around partnering with the community to help improve health by working through anchor community-based and faith-based organizations.
“Trusted has supported some of Better Health Network’s outreach activities around collaborating with faith and community-based groups particularly around the Affordable Care Act, and not only the health insurance options related to that and Medicare but also around how we can make sure health care is more community centered,” he said.