Coordinated Care Networks Announced
The following information is listed for historical purposes only. It will not be updated.
After an extensive review process, LDH is recommending five entities to administer Coordinated Care Networks (CCNs) for two-thirds of the State's Medicaid recipients:
- Louisiana Healthcare Connections, Inc (whose parent company is Centene)
- Amerigroup Louisiana, Inc
Entities that proposed a CCN-Prepaid but were not selected are:
- Aetna Better Health Inc.
- Children's Hospital Health Plan Inc.
- Coventry Cares of Louisiana Inc.
- Louisiana Cares Health Plan LLC
- United Healthcare of Louisiana Inc.
- Wellcare Health Plans Inc.
CCN-Shared Savings Networks
- UnitedHealthcare of Louisiana, Inc
- Community Health Solutions of America, Inc
An entity that submitted a proposal to be a CCN-Shared Savings but was not selected is:
- LA Physicians Connections LLC
See CCN Proposals
CCN Selection Process
LDH used a competitive procurement process to select the CCNs, with a Request for Proposals issued April 11. Medicaid will offer two types of CCNs, prepaid and shared savings, and will implement the networks within three Geographic Service Areas (GSA), enrolling recipients in phases. All of the CCNs being recommended by the evaluation teams would serve all GSAs.
LDH used a consensus scoring process to extensively evaluate all proposals. Five teams separately reviewed each proposal to examine a specific aspect of that proposer's ability to provide services for Medicaid recipients:
- Team 1: Qualifications and Experience; Added Value to Louisiana
- Team 2: Planned Approach to Project; Provider Network; Fraud and Abuse
- Team 3: Member Enrollment and Disenrollment; Member Materials; Customer Service; Emergency Management Plan; Grievances and Appeals
- Team 4: Chronic Care/Disease Management; Service Coordination; Utilization Management; EPSDT; Quality Management
- Team 5: Third Party Liability (CCN-P only); Claims Management; Information System
The teams met independently to score their specific areas, and then the review committee combined the five teams' scores to determine each proposal's total score. The recommendations were based on a potential CCN's qualifications, experience coordinating care for Medicaid recipients, additional benefits or value and how the network would work with patients and providers to improve health outcomes.
Several steps remain before CCN contracts are final and the networks are ready to begin operations. The Division of Administration must approve the evaluation process and the final contracts.
Additionally, CCNs will undergo a thorough readiness review before any network can begin providing services to Medicaid recipients. To ensure network adequacy, each CCN must demonstrate it has a robust network of primary care providers (and specialists, hospitals, and other provider types in the case of the prepaid CCNs) in place to treat patients, sufficient support staff to handle administrative processes and provider relations, and the ability to meet all the deliverables specified in its proposals. The Centers for Medicare and Medicaid Services, the federal agency that monitors states' Medicaid programs, will review each CCN's contract and network adequacy, and must approve these before recipient services can begin. Any CCN that cannot meet these rigorous readiness review requirements will not be allowed to operate in Louisiana.