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Health Plan of Michigan is the third largest Medicaid HMO in the State of Michigan, providing health care to over 130,000 Medicaid enrollees through a contract with the Michigan Department of Community Health (DCH). HPM is a privately owned and physician managed Medicaid health plan. Its corporate headquarters is located in Detroit, Michigan. Currently HPM operates in 41 counties.

HPM has achieved "Excellent" Accreditation from the National Committee for Quality Assurance (NCQA). That is the highest level that a health plan can obtain. In addition, HPM was rated 10th among all Medicaid health plans in the country according to U.S. News and World Report magazine.

Our Mission:

Improving the quality of care in a low resource environment.

Our Vision:

To be one of the Top 3 Medicaid health plans in the State of Michigan providing quality health care to our members. To be ranked among the Top 10 Medicaid health plans nationally.

Key Features:

• A Michigan-based company
• Physician owned and operated
• Committed to quality
• Innovative and User Friendly Managed Care System (MCS)
• Robust Physician Network with over 1,700 PCP's, 4,300 Specialists and 77 Hospitals
• Prompt Claims Payment; within 10-Days or Less
• NCQA "Excellent" Accreditation

CORPORATE INFORMATION

Corporate History

Health Plan of Michigan is a Medicaid health plan contracted with the Michigan Department of Community Health (DCH) to provide health care services. Health Plan of Michigan was formed from the merger of two clinic plans, Central Michigan Health Plan (CMHP) and American Preferred Provider Plan of Michigan (APPPM). CMHP was founded by physicians at the Jackson Northwest Clinic located in Jackson, Michigan in December of 1996.

In August of 1997, Dr. David B. Cotton acquired a majority position in CMHP and assumed fiscal and administrative responsibility for the plan, which had approximately 1,400 members. CMHP acquired APPPM in January of 1999 and ultimately became operational as Health Plan of Michigan in May of 1999. In January of 2000, HPM acquired the Michigan membership of Family Health Plan of Ohio.

Health Plan of Michigan has operated as a full service HMO since January of 2000. Health Plan of Michigan obtained NCQA accreditation in May of 2002. HPM remains a physician owned and physician managed health plan.

Provider Network and Service Area

Health Plan of Michigan currently operates in 41 counties throughout the State of Michigan. We have developed one of the largest Medicaid provider networks in the State of Michigan, including:

• 1,700 Primary Care Providers
• 4,300 Specialists
• 77 Hospitals

HPM is continually seeking ways to improve access within our service area, as well as expanding into new service areas.

The HPM option is currently available to eligible Medicaid recipients residing in the Plan's service area which includes the Michigan counties of Allegan, Barry, Berrien, Branch, Calhoun, Cass, Clinton, Crawford, Eaton, Genesee, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lake, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Roscommon, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren and Wayne.



Service Description

HPM provides a wide range of Medicaid covered benefits for its enrollees including preventive care, physician office visits, diagnostic tests, home health care, inpatient hospital care and emergency room treatment. All services are provided based on the State of Michigan Medicaid benefit guidelines.

HPM's philosophy is to function as a care management and preventive care organization with an emphasis on disease management. The following are some of the beneficial services provided by Health Plan of Michigan:

Member Outreach - Each new member receives a welcome call within the first 30 days of enrollment to verify their primary care provider selection and to explain HPM's managed care processes. In addition, members receive periodic telephone calls to remind them of important preventive services such as well child visits, immunizations, prenatal care and other screenings.

Case Management - Members entering the health plan with multiple medical issues are identified and immediately assigned to a case manager trained to develop interventions that can result in lower hospitalization rates. The overriding philosophy of HPM is to deliver as many outpatient services as necessary to maintain member health and avoid an inpatient admission.

Disease Management - HPM has developed disease management programs that are rolled out to the entire eligible membership. These programs include Diabetes, Asthma and Heart Disease. Members in the disease management programs are stratified based on claims data and are assigned to a level of one through three, with three being the most complex. The Disease Management department provides education and outreach to members and providers

Health Risk Assessment (HRA) - Members are contacted via phone and are interviewed regarding their medical history. Based on the results of the HRA, the members are assigned to disease management programs or case management services, as appropriate. Members not acute enough to require case management are screened for required preventive services and are contacted through HPM's health outreach program and are actively encouraged to obtain the necessary care.

All of the data gathered through these activities is captured in HPM's state of the art managed care system (MCS). This allows for a comprehensive approach to preventive care and health management for our members and providers.

Commitment to Quality

The State of Michigan uses the nationally recognized Health Plan Employer Data and Information Set (HEDIS) to compare quality among the health plans serving the Medicaid population. HPM has made HEDIS improvement a corporate priority, with a goal of becoming one of the Top 3 Medicaid health plans in the State of Michigan in terms of its HEDIS performance.

In 2006, HPM was among the top three Medicaid health plans in the State of Michigan for the following HEDIS measures:

• Adolescent Well Care
• Appropriate Asthma Medications (Combined Rate)
• Children's Access to PCP - 2 to 6 Years
• Children's Access to PCP - 7 to 11 Years
• Children's Access to PCP - 12 to 19 Years
• Well Child 0-15 Months (6 or More Visits)
• Well Child 3-6 Years
• Controlling High Blood Pressure

Throughout the year, HPM monitors its HEDIS performance and conducts improvement activities to meet its goals, including education and outreach to members and providers.

NCQA Accreditation

Health Plan of Michigan is fully accredited by the National Committee for Quality Assurance (NCQA). NCQA is an independent non-profit organization that is considered the premier source for information about the quality of the nation's managed care plans.

NCQA Accreditation is designed to help consumers and purchasers distinguish between health plans based on quality. Accreditation is rigorous and comprehensive evaluation process through which NCQA assesses the quality of the core systems and processes that make up a health plan. This process includes a document review and an on-site visit to the health plan offices. Accreditation evaluates not only those core systems and processes, but the results that the health plan actually achieves on key dimensions of care and service.

NCQA's accreditation program is voluntary and has been universally accepted as an objective measure of quality. To learn more about NCQA and the standards that Health Plan of Michigan has met in order to achieve accreditation, please visit the NCQA website at www.ncqa.org.