UP for the challenge

UP for the challenge

August 1, 2005

On paper, the challenge in the South Carolina managed care market is pretty obvious: South Carolina has about a 5.8% managed care penetration rate, compared with the national average of 23.7% (Kaiser State Health Facts).

Although managed care plans might not have gained substantial market share or influence in South Carolina, under the leadership of CEO J. Michael Jernigan-and support of AmeriHealth Mercy Health Plan-Select Health of South Carolina, a health insurer licensed by the South Carolina Department of Insurance, has proven to the state that Medicaid managed care works, and is flourishing.

Since 2001, Select Health has saved the state of South Carolina more than $6 million.

One of Select Health's greatest challenges has been helping providers overcome their suspicions of managed care and dispelling their myths about the Medicaid population, according to Jernigan.

"We've overcome that challenge through collaboration, education and outreach, and by proving to each of our providers that we can help them reach their growth goals," he says.

Select Health has been marketing its Medicaid health plan, First Choice, as a voluntary option for Medicaid-eligible families, since 1996. As the state's largest provider of Medicaid medical homes, Select Health and its provider network serve more than 58,000 members in 29 South Carolina counties.

The First Choice plan commands a network of more than 2,500 providers, 38 hospitals and 731 pharmacies.

"All four of South Carolina's children's hospitals and the Medical College of Georgia's children's hospital participate in our network," he says. "As a result of our strong pediatric network and the aid categories eligible for our plan, 85% of our members are children."

In addition to maintaining strong provider relationships, Jernigan believes that it is important to enlist community organizations and healthcare associations that are part of the policy-making process for Medicaid services in South Carolina.

Q. It has been said that disease management is difficult to implement in Medicaid for a variety of reasons. Do you believe this is true?

A. I see this as a perfect opportunity to implement disease management-especially for chronically ill members. We have developed a number of disease and care management programs to assist our high-risk members. The disease management programs include: Sweet Choices for adult diabetics; Breathe Easy for pediatric asthmatics; Healthy Babies for high-risk pregnant members; and Sickle Cell for members who suffer from sickle cell disease. In each of these programs, we identify high-risk members affected by the chronic conditions, make contact with them and then offer education and opportunities to improve their medical care.

For those members who unfortunately are only eligible for Medicaid for a short period of time, it's much more difficult to implement disease management programs that can have measurable impact. For those individuals who maintain Medicaid eligibility for a year or more, we believe that we can help improve their health status.