AmeriHealth Caritas Pennsylvania started more than 25 years ago with the idea that by connecting Medicaid members to a doctor and a medical home - that is, improving access to care - it would be possible to improve the quality of care and lower costs.
It all started in the early 1980s when the staff at Misericordia Hospital, a health ministry of the Sisters of Mercy in West Philadelphia, noticed that many of its Medicaid patients were using the emergency room for their primary care. That was - and still is - a very expensive and inefficient way to receive medical care.
To address this issue, they created Mercy Health Plan, a voluntary Medical Assistance managed care plan that later became AmeriHealth Mercy Health Plan. It helped connect each member with a primary care physician to encourage consistent and proactive health care.
Over time, more Medicaid recipients began seeing their primary care doctors on a regular basis, rather than putting off care until the condition got so severe they had to go to the emergency room.
In 1988, Mercy Health Plan expanded to Berks, Lancaster and Lehigh counties, planting the seeds of AmeriHealth Caritas. Over the next several years, the plan grew to eventually include 15 counties in Central and Northeastern Pennsylvania.
From that modest start in 1983 with only 300 members, the plan has grown and become a leader of health care solutions for the underserved.
In 1992, Mercy Health Plan's commitment to access and quality care helped it to become the first Medical Assistance plan to earn full NCQA Accreditation. NCQA accreditation is a nationally recognized evaluation standard that purchasers, regulators and consumers can use to assess health plans.
Mercy Health Plan continued to grow, and in 1996, it entered into a partnership with AmeriHealth First to form AmeriHealth Mercy Health Plan. With the experience of AmeriHealth First and Mercy Health System behind it, AmeriHealth Mercy Health Plan blossomed and grew.
Today, the plan serves more than more than 100,000 Medical Assistance recipients in the 15-counties of Central and Northeastern Pennsylvania.