MyGateway Medicaid Medicare Assured SM News Careers Contact Us
Medicare + Medicaid = More.  
About Gateway

About Gateway Health Plan®

Gateway Health Plan® (Gateway) was established in 1992 as an alternative to Pennsylvania’s Department of Public Welfare's Medical Assistance Program. Gateway Health Plan® provides service to more than 250,000 members eligible for Medical Assistance. In January 2006, Gateway launched Gateway Health Plan Medicare AssuredSM, a Medicare approved Special Needs Plan in Pennsylvania for individuals who are eligible for both Medicare and Medicaid and live within Gateway’s service area. Gateway currently operates Gateway Health Plan Medicare AssuredSM in 27 Pennsylvania counties and 12 Ohio counties.

Gateway Health Plan Medicare AssuredSM is among the largest Medicare Special Needs Plan in the nation for the dually-eligible population with more than 24,000 members.

Innovative Leadership
Under the direction of Michael Blackwood, President and CEO, Gateway Health Plan® has become a leader in innovation while remaining focused on ensuring access to quality care for our most needy citizens.

Top Honors
Gateway Health Plan® is one of the nation’s top Medicaid health plans. For the past four consecutive years, U.S. News & World Report and the Committee for Quality Assurance (NCQA) placed Gateway Health Plan® among the highest rated Medicaid health plans in the country. The 2007 report, National Committee for Quality Assurance “America’s Best Health Plans,” ranks Gateway Health Plan® #12 among 196 Medicaid plans nationwide. It is the top-ranked Medicaid plan in Pennsylvania. In 2006, the National Committee for Quality Assurance (NCQA) awarded its highest, four-star accreditation status of “Excellent” to Gateway for its Medicaid HMO product. According to the NCQA, achieving excellent accreditation status is significant because it is only awarded to those plans that meet or exceed rigorous requirements for consumer protection and quality improvement. Further, Excellent accreditation status requires Health Plan Employer Data and Information Set (HEDIS) results in the highest range of national performance. Specifically, NCQA looked at how easy it is for Gateway members to get care and services, how well Gateway helps its members remain healthy and avoid illness, how well Gateway cares for its members when they are ill, and members with chronic illness, and how well Gateway rates doctor’s care provided to members. Gateway has one of the highest Health Plan HEDIS scores in the nation for Medicaid—in excess of 98 percent.

Quality
Making quality the basis of performance demonstrates Gateway’s underlying dedication to member satisfaction. Gateway’s 2004 Consumer Assessment of Health Plans (CAHPS) scores revealed a profound satisfaction among members by receiving a perfect score that equates to the Health Plan meeting or exceeding all established standardized measurements at the 90th percentile or above. As an independent agency, the NCQA results indicate the strength of Gateway Health Plan®’s overall member services, from efficient and timely claims processing to assisting its members in receiving the care they need. While earning the NCQA “Excellent” level of distinction places Gateway in the highest tier of health insurers in America, at the same time, Gateway has reduced its administrative cost ratio to below eight percent.

Managing Care Compassionately
At Gateway, we prove that it is possible to be both compassionate and viable. Gateway’s priority has been to ensure that care is delivered in the most cost-effective manner commensurate with the individual member’s needs.

Gateway is working with providers and others involved with our members’ care to address specific health needs. Programs focused on managing diabetes, preventing and treating obesity, smoking cessation among pregnant mothers, controlling asthma, and a multitude of other initiatives are testimony to Gateway’s commitment to improving the quality of life and health status of our members and serve as a model for others to emulate.

Prospective Care Management (PCM®) “Meeting Members Where They Are”

Innovatively Addressing the Needs of Those in Our Community

Over the past several years, Gateway Health Plan® has designed and implemented an enhanced healthcare management model called Prospective Care Management (PCM®). PCM® addresses the unique challenges faced by our most vulnerable citizens in accessing medical and social support services. This approach uses cutting-edge techniques to examine the varied aspects of a person’s life – behavioral, environmental, economic, medical, social, and spiritual (BEEMSSSM) – to understand and help overcome the barriers to care.

The goal of PCM® is to improve the overall health status and maintain the well-being of each member. By “Meeting Members Where They Are” in their lives, PCM® focuses on addressing issues that stand in the way of accessing the healthcare system and living healthier lives.

Going Beyond Traditional Disease and Care Management
PCM® takes a proactive, holistic approach to design an individualized plan of care. Gateway’s care coordination staff provides disease specific education, instruction in self care, and helps locate referrals to community-based services. Gateway collaborates with physicians and community organizations to implement a treatment plan that addresses each member’s unique needs.

Building Invaluable Community Partnerships
Gateway recognizes the importance and value of partnering with physicians, providers and community agencies in the management of the medically and socially complex issues of our members. To improve member functional status and quality of life, we encourage and seek out the participation of these partners.

Actively Engaging Members and Their Caregivers
The PCM® approach centers on actively engaging members and their caregivers to anticipate problems rather than simply react to them. Once interventions have been established, continuous feedback of information allows Gateway to comprehensively update the treatment plan.

The following case studies show how PCM® can make a difference in the lives of our members:
Member Challenge #1

Member Challenge #2
Member Challenge #3

These and countless other stories showcase how PCM® helps Gateway members take charge of their health and wellness. By targeting members who are at higher risk for developing serious health issues, PCM® is critical to our ongoing efforts to foster a healthier member population.

Ensuring Quality Care
An 18-member Quality Improvement Committee strives to keep Gateway on the road to continuous improvement. Since Gateway’s inception, the Committee has played a critical role in the organization’s success. The QI Committee, which is made up of experts in a wide variety of medical fields, assesses all of Gateway’s efforts to ensure the delivery system results match the organization’s high standards for quality.

The Committee not only assesses Gateway’s ongoing efforts, it also works to assess new protocols and clinical guidelines to improve care. For example, the Committee members worked with a number of neonatal intensive care unit physicians across Western Pennsylvania to create guidelines for the proper care of premature infants. The guidelines are helping to reduce the rate of clinical complications for premature babies.

In 2007, the Committee worked with practicing physicians to introduce clinical guidelines designed to ensure the proper care for babies born to drug addicted mothers. In addition, a comprehensive training video was created to teach nurses how to remove drugs from babies’ systems and put them on the road to better health.

Gateway is dedicated to providing the best care to our members. That means making sure the provider and measurement systems are in place to ensure high quality care and making sure it actually reaches the member at the ground level.

Wellness and Education
Community wellness begins with awareness and prevention.

Gateway Health Plan® brings a variety of educational outreach seminars and other support services designed to actually keep people out of the hospital. Gateway also participates in a number of programs to help train tomorrow’s health care professionals in many fields, strengthening our pool for future caregivers.

Gateway Health Plan® supports our mission by being a strong, positive partner in the community. Gateway believes that as a health plan, Gateway has a responsibility to improve the health and quality of life of our members as well as the community-at-large. Gateway Health Plan® community contributions include:
  • Participation in community events
  • Sponsorships
  • Board and committee technical support
  • Volunteer activities
  • Health Education programs

Gateway Health Plan® is committed to perpetuate that spirit of giving in the coming years, with a focus on providing access to the highest quality care.

Gateway Health Plan
Lucky HeartMore than healthcare.
Copyright 2008 Gateway Health Plan®   Home   About Gateway   Privacy   Fraud and Abuse Policy   Sitemap Last Updated: 5/23/2008