Total membership at Highmark Wholecare, formerly Gateway Health, exceeds 410,000 as a result of new HealthChoices contract implementation

PITTSBURGH, Jan. 11, 2023 /PRNewswire/ — The recent implementation of the new Pennsylvania HealthChoices Physical Health contract has resulted in Highmark Wholecare, formerly Gateway Health, increasing its Medicaid membership by nearly 25 percent to more than 375,000 members. Total membership at the health plan, which includes Medicaid and Medicare Dual-Special Needs plans, exceeds 410,000.

“We are honored to have so many Pennsylvanians choose Highmark Wholecare to help them manage their health care,” said Ellen Duffield, president and CEO, Highmark Wholecare. “Our corporate headquarters are in Pittsburghour providers are state-based, and our members reside exclusively in pennsylvania. The majority of our team members live and work in the Commonwealth. Our members are our neighbours.”

Established in 1992, Highmark Wholecare is a leading mission-driven, community-based managed care organization dedicated to caring for the total health of its members. Through its robust Medicaid and Medicare plans – and in collaboration with a network of 29,000 primary care physicians, specialists, hospitals, community partners and other ancillary providers – Highmark Wholecare coordinates health care that goes beyond doctors and medicine to help members achieve whole life health.

“We believe the results of the HealthChoices implementation are a testament to our whole health approach to care, particularly for our Medicaid members,” Duffield said.

Through a competitive procurement process, the Pennsylvania Department of Human Services (DHS) changed which Physical Health managed care organizations (MCOs) were available to Medicaid beneficiaries in each of the state’s five zones for the new Physical HealthChoices contract. These changes resulted in millions of thousands of Medicaid beneficiaries having to switch their MCOs. Beneficiaries who were required to switch could do so voluntarily for a two-month period ending Aug. 16, 2022. Beneficiaries who were required to switch MCOs but did not were assigned new MCOs by DHS beginning Aug. 17, 2022 for coverage beginning Sep. 1, 2022.

During the HealthChoices voluntary enrollment period, Highmark Wholecare placed second out of five MCOs in the number of voluntary enrollments in both the Lehigh-Capital and Southwest zones.

“We pride ourselves on being a community-based health plan, supporting not only our members in partnership with our provider network, but also organizations within the communities we serve that provide additional resources and assistance that our members need,” Duffield added. “We are proud to help local businesses and non-profits in pursuit of providing our members with the best care possible so they can live healthier lives and achieve not just physical health, but whole life health.”

In 2021, Highmark Health acquired full ownership of Gateway Health, after previously holding a 50 percent ownership interest. This paved the way for the organization to become a Blue Cross Blue Shield licensee. Highmark Wholecare Blue Cross and/or Blue Shield Medicaid and Medicare Advantage Dual-Special Needs branding for the health plan began on Jan. 1, 2022.

About Highmark Wholecare

We believe in caring for the whole person in all communities where the need is greatest. We see a future in which everyone has equal opportunity to achieve their best health. Through our leading Medicaid and Medicare programs, we are coordinating health care that goes beyond doctors and medicine that helps members achieve not just physical health, but also delivers whole person care. Our team members are helping to drive this new kind of health care for our 410,000 Medicaid and Medicare members in collaboration with a network of 29,000 primary care physicians, specialists, hospitals, and other ancillary providers. We are also committed to supporting our neighbors through our many community outreach and engagement programs.

SOURCEHighmark Wholecare


Leave a Comment