West Virginia Public Employees' Insurance Agency (Charleston, WV)

The Pacific Health Policy Group (PHPG) served as consultants to the three public healthcare purchasers in West Virginia:

1. The Department of Health and Human Resources (DHHR), responsible for Medicaid;

2. The Public Employees' Insurance Agency (PEIA), responsible for furnishing health benefits to state, county, and education employees, retirees, and dependents; and

3. Workers' Compensation.   

PHPG has assisted the three agencies in developing a coordinated strategy for purchasing health care services, to improve access, encourage a more integrated health care delivery system, and manage costs.

Activities included:

• Assisting in a joint procurement of managed care services by DHHR and PEIA

• Evaluating options for combined purchasing of pharmaceuticals across the three agencies

• Conducting cross-agency operational audits of existing managed care plans

• Conducting extensive operational reviews of plan performance

• Development of competitive procurement process, including drafting an RFP, evaluation guide, and technical assistance in the review of proposals

• Design and implementation of a telephone satisfaction survey of 3,000 PEIA beneficiaries enrolled in managed care or the indemnity insurance program

PHPG assisted the Health Care Authority in drafting the 2000-2002 State Health Plan and also designed and assisted in the implementation of a statewide program for claiming reimbursement under Title XIX for school-based health services.   During the first year, the state obtained approximately $25 million in new federal funds.