Our Focus in Health Care
The following services are available to promote health and well being through education, collaboration and support.
Care Coordination
Disease Management
Catastrophic Case Management
Care Partners
Care Coordination
Care Coordination allows members and providers to focus on what matters most — getting well and staying well! Led by AHP’s Chief Medical Officer, this program allows us to stay focused, disciplined and accountable to all our customers, members and providers. Care Coordination builds relationships that enable us to make a difference in the lives of the individuals we serve.
Care Coordination may:
- Offer help with transitional care needs and information on community resources
- Build member confidence with consistent, coordinated care
- Provide continual assistance as a member moves through the healthcare system with a single point of contact
- Organize delivery of durable medical equipment
- Offer direction with utilization of pharmacy benefits and treatment plans
- Support members’ health and wellness needs
Care Coordination is available to:
- Members with known, or who are predisposed to, chronic illnesses
- Members facing compliance issues in accessing health care or following a prescribed course of treatment
- Members interested in maintaining a healthy lifestyle
- All members, regardless of age
- New members to Avera Health Plans
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Disease Management
AHP and Avera Health Plans Benefit Administrators (AHPBA) Disease Management support programs have demonstrated success in improving clinical outcomes, increasing self-management of chronic medical conditions and increasing satisfaction for both members and providers. Those we coach, educate and support through our disease specific support programs do better, feel better and report a higher quality of life.
Disease Management Support Program Options:
- Asthma
- Back and Spine Conditions/Chronic Pain
- Coronary Artery Disease
- Diabetes
- Gastrointestinal Diseases
- High-Risk Maternity
- Obesity
Program Objectives:
- Improve population health
- Encourage use of best practice guidelines
- Achieve positive patient outcomes
- Reduce impact of chronic disease
Desired Outcomes:
- Healthy behaviors
- Improved clinical performance
- Member and provider satisfaction
- Optimal utilization and patient responsibility
- Improved financial performance for employers
Program standards support best practices of the Institute for Clinical Systems Improvement (ICSI) and other appropriate professional organization standards.
Our support programs provide an approach using high intensity interventions for improving the health and status of AHP members diagnosed with select chronic disease states that may lead to adverse outcomes. Specially qualified to manage and monitor chronically ill patients, our Health Coaches offer valuable support.
Members eligible for a support program are identified using a combination of predictive modeling, health risk assessments, and assessment of readiness to change. Our industry-recognized application of key behavior change principles, integrated in our support system, ensures that each intervention is based on individual levels of confidence. Incentive-based models may be used to encourage participation.
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Catastrophic Case Management
AHP is committed to making a difference in the lives of the individuals we serve. One way we can make a difference is through case management, which identifies patients with special needs, assesses the severity of the illness and intervenes to coordinate available services. In addition to coordinating available services, case management also:
- Monitors medical services provided
- Plans for overall care
- Evaluates services delivered
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Care Partners
Care Partners creates a unique partnership between Employers, Employees, Account Representatives and Community Nurse Advocates that promotes improved health, better manages costs, and may improve the overall wellness of the group.
Employers tell us they want to achieve these goals:
- Improve employee satisfaction
- Control healthcare costs
- Reduce risk
- Decrease absenteeism and illness
- Improve lifestyle choices
- Promote intervention
- Hassle-free health plans
As a team, Care Partners finds ways to improve health and encourage behavior modification with:
- Employee education meetings
- Wellness programs
- Lunch and Learn sessions
- Health risk assessments
- Employee newsletters and payroll stuffers
- Pharmacy education
- Preventive care reminders
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