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Amerihealth Caritas

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AmeriHealth Caritas Company Research Report



Company Overview



  • Name: AmeriHealth Caritas Family of Companies

  • Mission of the Company: To help people get care, stay well, and build healthy communities.

  • Founded: 1983 in a West Philadelphia hospital.

  • Key People:

  • President and CEO: Kelly A. Munson

  • Regional President (Pennsylvania): Russell Gianforcaro

  • Market President (Pennsylvania): Joanne McFall

  • PerformCare President: James Laughman

  • PerformRx President: Jim Gartner

  • Headquarters: No specific location mentioned.

  • Number of Employees: No information is available.

  • Revenue: No information is available.

  • Known For: AmeriHealth Caritas is known as a national leader in health care solutions for people who are at a low-income level and/or are chronically ill. The company is one of the largest and most respected Medicaid managed care organizations in the country.


Products and Services



Products


1. Medicaid Managed Care
  • Description: Specializes in providing cost-effective, high-quality care and improving Medicaid's base services with innovation and flexibility.

  • Key Features: Coordination of member benefits, cost reduction, and community outreach initiatives.


2. Medicare and Dual-Eligible Plans
  • Description: Provide support for people eligible for both Medicare and Medicaid, focusing on complex health needs.

  • Key Features: Dual-Eligible Special Needs Plans, Medicare-Medicaid Plans, preventive services, and care management.


3. Individual and Family Health Plans
  • Description: Robust health plans that work towards providing affordable health care, both on and off the Exchange.

  • Key Features: Includes gold, silver, and bronze plans, focusing on 10 essential health benefits.


4. Long-Term Services and Supports (LTSS)
  • Description: Offers a complete range of services for elderly and disabled individuals to stay healthy in their homes and communities.

  • Key Features: Bathing, eating, taking medications, and other daily activities support.


5. Behavioral Health Care
  • Description: Through PerformCare, provides mental health services focusing on overall well-being.

  • Key Features: Includes intellectual and developmental disability services, emergency interventions, and substance abuse treatments.


6. Pharmacy Benefits Management
  • Description: Through PerformRx, offers comprehensive, clinically focused pharmacy benefit solutions.

  • Key Features: Maintaining formularies, drug benefits, prescription drug claims, and contracting with pharmacies.


Recent Developments



  • New Products Launched:

  • Expansion of AmeriHealth Caritas Next℠ product in North Carolina counties for 2025.


  • New Features Added:

  • Specialty pharmacy and behavioral health plans with personalized care management.

  • Innovation in Medicaid managed care with dual-eligible solutions.


  • Partnerships and Collaborations:

  • Collaborated with Zest Pediatric Network in Ohio to improve child health care through value-based programs.

  • Launched a pilot nutrition program to improve food security for older adults in Pennsylvania.


Additional Information



  • National Footprint: AmeriHealth Caritas operates approximately 5 million members in 13 states and the District of Columbia.

  • Community Engagement: Focused on supporting diverse businesses, addressing social determinants of health, and serving underserved communities.

  • Awards and Accreditations:

  • Multiple NCQA accreditations in health equity, long-term services, behavioral health organization, and pharmacy benefit management.


_No additional information is available for fields not mentioned in the data provided._