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Managed Care & Population Health Partnering for Better Health Through Value-Based Care

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UTMB’s Managed Care & Population Health team supports quality-driven, patient-centered care through strategic programs, partnerships, and analytics.

At UTMB, we believe that better outcomes come from better alignment. Our Managed Care and Population Health team works across departments and payers to drive success in directed payment programs, value-based contracts, and other Alternative Payment Models (APMs)—improving quality, access, and equity for the patients we serve.

Services

Monitoring Tools
Documentation Best Practices

Value-Based Care

Medicaid

Texas Medicaid Managed Care Delivery

Texas Medicaid is primarily delivered through managed care programs, where most beneficiaries receive their healthcare through contracted health plans. The main program is STAR, which covers low-income children, pregnant women, and families, and individuals enroll in a health plan within their service area. Other programs include STAR Kids, STAR+PLUS, and STAR Health, each with specific eligibility requirements.

Here's a breakdown of the Texas Medicaid structure

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  • Managed Care Delivery
    • STAR: This is the main managed care program for children, pregnant women, and families.
    • STAR Kids: Specifically for children and adults 20 and younger with disabilities.
    • STAR+PLUS: For adults with disabilities, those 65 or older, and women with breast or cervical cancer.
    • STAR Health: For children in foster care.
  • Enrollment and Choice
    • When someone is approved for Medicaid, they receive a packet with information about choosing a health plan within their service area.
    • If a beneficiary doesn't choose a plan, the state will assign them one.
    • Texas Medicaid and CHIP encourage value-based care, which means plans are evaluated on quality and efficiency metrics.
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  • Comprehensive Hospital Increase Reimbursement Program (CHIRP)

    The Comprehensive Hospital Increase Reimbursement Program (CHIRP) is a statewide program that increases Medicaid payments to hospitals for inpatient and outpatient services provided to persons with Medicaid. Texas Medicaid managed care organizations (MCOs) receive additional funding through their monthly capitation rate from the Texas Health and Human Services Commission (HHSC) and are directed to increase payment rates for participating hospitals. As designed, eligible hospitals receive a percent increase paid on claims submitted to a Medicaid MCO. CHIRP’s purpose is to advance goals and objectives in the state’s Medicaid quality strategy by incentivizing improved quality and access for hospitals that serve persons with Medicaid.

    Comprehensive Hospital Increase Reimbursement Program (CHIRP) 

  • Texas Incentives for Physicians and Professional Services (TIPPS) Program

    TIPPS is a physician-directed payment program (DPP) for certain physician groups to help cover the cost of healthcare services provided to persons with Medicaid enrolled in STAR, STAR+PLUS, and STAR Kids. Eligible physician groups include Health-Related Institution (HRI) physician groups, Indirect Medical Education (IME) physician groups, and other physician groups. These classifications allow the Texas Health and Human Services Commission (HHSC) to direct reimbursement increases where they are most needed and to align with the program’s quality goals.

    Texas Incentives for Physicians and Professional Services (TIPPS) Program 

  • Medicaid Value-Based Agreements
    Equality Health is UTMB’s collaboration partner supporting the needs of patients under 4 managed Medicaid plans (Community Health Choice, Superior, United and Wellpoint). This arrangement allows UTMB to focus on care delivery and completion of quality care gaps while Equality Health provides administrative and social support to help the attributed patients.

Medicare

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Commercial Value-Based Agreements

  • Blue Cross Blue Shield
  • Cigna

Meet the Team

Susan Seidensticker, MSHAI, CPHQ, CSSBB, PMP

Director Managed Care & Population Health
Phone: 409-766-4041
Email: smseiden@utmb.edu
Portrait of Susan Seidensticker, MSHAI, CPHQ, CSSBB, PMP

Brenda Bochas

Medical Assistant II
Phone: 409-266-1401
Email: brbochas@utmb.edu

Amanda Craft

Patient Services Specialist II 
Phone: 409-266-1401
Email: ammcraft@utmb.edu

Elneza Ellis

ACO Care Manager
Phone: 409-747-0657
Email: eaellis@utmb.edu

Andrew Herndon, MHA

Director Managed Care & Population Health
Phone: 409-766-4044
Email: atherndo@utmb.edu
Portrait of Andrew Herndon, MHA

Dwo Chu

Business Intelligence Analyst
Phone: 409-266-0687
Email: chiachu@utmb.edu

Mandy Hutchinson

Software Systems Specialist
Phone: 409-747-0815
Email: mjhutchi@utmb.edu