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McWaters, became familiar with the challenges of the healthcare industry at an early age because his mother was employed by a group of physicians. He joined Hospital Affiliates, owned by Insurance Co.
In the right place at the right time, McWaters was able to gain valuable experience at a young age about the inner workings of an emerging industry. He learned how an entrepreneur set about securing venture capital, and when he was sent to Dallas to help open an office for Hospital Affiliates, he learned how to build a business.
He told Managed Healthcare Executive in , "We didn't even have a checkbook to balance when we started. We had no policies or procedures, no infrastructure, no computer system, nothing.
We did it all from scratch. Everything McWaters learned at Hospital Affiliates would prove useful in his next venture in when he helped psychiatrist Ronald I. Dozoretz to found Options Mental Health, one of the first managed behavioral care companies in the country. McWaters became the chief executive officer of the Norfolk, Virginia-based company that developed customized mental health and substance abuse programs for federal, state, and local Medicaid populations.
As he explained to Managed Healthcare Executive, "It became clear to me that the Medicaid and uninsured populations were both very large and growing.
It was still being managed by a s-era healthcare system. Patients couldn't be seen, and doctors weren't getting paid enough. He struck out on his own in to start a new HMO dedicated to serving Medicaid recipients, primarily children and expectant mothers, literally working out the business plan on his kitchen table. The approach McWaters took was similar to disease management, although the needs of the Medicaid population were not as constant. The HMO would concentrate on a few core disease states perinatal, asthma, diabetes, and sickle cell anemia , but the essential thrust was to provide education and guidance, for instance, steering patients to a primary care physician with whom they could develop a beneficial relationship rather than relying on a hospital emergency room for routine healthcare.
Moreover, Americaid would tackle other obstacles that stood in the way of patients receiving effective healthcare, relieving doctors of burdens normally shouldered by social workers, such as taking care of transportation and helping patients to find better housing. While McWaters was targeting a high-maintenance population, it was one that offered a higher margin than the general population, as well as being more cooperative, because it was younger, responded well to treatment, and recovered more quickly.
It was also a market neglected by major HMOs, presenting McWaters with a significant niche opportunity. He decided to house his new company in Virginia Beach, Virginia, despite having no desire to serve the Virginia market. Rather, he chose the city because of its central location, quality of life, and educated workforce. McWaters then spent the next year applying for licenses in the states in which he wanted to operate, developing the products and necessary healthcare systems, and recruiting and training personnel.
The first Americaid operation was launched in New Jersey in February By the end of the year the subsidiary enrolled 10, members.
Americaid Illinois followed in April and signed up 2, members in Chicago. Then in September Americaid Texas got started in Fort Worth and by the end of the year had 21, members. The company developed a consistent approach to entering a new market, starting out by inviting community leaders to focus groups and hiring some to serve as consultants to provide insights to the community and to act as outreach workers.
The company also sought out the people to whom Medicaid recipients were likely to turn for advice, educating clergy and area social service workers about how the Americaid plan worked.
Because most states did not permit Americaid to market itself directly to Medicaid markets, the company placed information where potential members were likely to frequent, such as churches, Head Start programs, day-care centers, and supermarkets. After the company achieved a toehold in the community it relied on word of mouth to build membership. Americaid won a bid to enroll Medicaid members in Fort Worth, Texas, signing up 2, by the end of the year.
The company also began to branch out beyond the Medicaid population. According to federal law at least 25 percent of its membership had to be commercial enrollees. In addition, the company launched a Medicare HMO and another for "dual-eligibles," people covered by both Medicaid and Medicare. Because of this product expansion, the company decided to change its name to something more inclusive, becoming Amerigroup Corporation.
Amerigroup enjoyed strong growth in , as membership topped the , mark, reaching , by the end of the year. Membership in Illinois doubled to 10, while the New Jersey plan grew from 10, to 38,, mostly the result of the company acquiring Oxford Health Plan's Medicaid business in the state. The greatest increases, however, were achieved in Houston, when in the first full year of the plan's operation 40, members were enrolled.
Nevertheless, it was an impressive showing for a young company and, more important, just a taste of what was in store for Amerigroup more than doubled in size in , the result of acquisitions as well as entering markets from scratch. Amerigroup picked up 75, Medicaid recipients in Maryland and added another 8, by the end of the year. In the District of Columbia, Amerigroup acquired another 11, members and enrolled 1, over the next several months.
Convened by Lex Frieden , who was instrumental in conceiving and drafting the Americans with Disabilities Act of , the NAB is made up of 19 community advocates, health care experts and academics. The main goals of the Amerigroup Foundation are to foster access to care, encourage safe and healthy children and families, and promote community improvement and healthy neighborhoods. Amerigroup has a Community Volunteers program, created to recognize and support the contributions employees make in communities across the country and to inspire others to volunteer.
Former Executive Cleveland Tyson provided federal prosecutors with evidence that Amerigroup was systematically declining services to low-income pregnant women in Illinois from to Their contract with the state required that they enroll all eligible clients, but prosecutors submitted emails showing that Amerigroup had a policy of targeting healthy enrollees and specifically excluded pregnant women and others with expensive conditions.
From Wikipedia, the free encyclopedia. Retrieved 22 February Amerigroup Corporation. Archived from the original on 26 January Securities and Exchange Commission. Retrieved 28 June Archived from the original on Retrieved 17 June Archived from the original on 3 August Amerigroup Foundation.
The Business Journals. Archived from the original on 18 January Chicago Tribune. Retrieved 21 March Illinois Attorney General. August 14, Retrieved March 21,
Medicaid and Medicare Insurance | Amerigroup Learn more about your coverage options after the Public Health Emergency (PHE) ends. Put Your Medicare Benefits to Work Learn more . As one of the nation�s leading health plans, Amerigroup serves millions of members in state-sponsored programs across the nation. Amerigroup Providers Arizona Georgia Iowa New . Amerigroup is an American health insurance and managed health care provider. Amerigroup covers million seniors, people with disabilities, low-income families and other state and federally sponsored beneficiaries, and federal employees in 26 states, making it the nation�s largest provider of health care for See more.