As previously communicated, all commercial AmeriHealth Pennsylvania HMO
members and AmeriHealth New Jersey Medicare Advantage HMO members were
transitioned to the Primary Health Coach model. The Primary Health Coach model
gives members a single point of contact for all issues and concerns related to
disease/condition and case management (this combination is called care
management).
As of January 1, 2016, AmeriHealth New Jersey will
transition all commercial HMO and PPO members to the Primary Health Coach
model. Therefore, upon this transition, all AmeriHealth membership will operate
under the same model.
The following table describes our former care management programs and the
changes that will be made for AmeriHealth New Jersey members as a result of
this transition to the Primary Health Coach model:
| Program | Program
description | Former program | Changes
for new model |
|---|
| ConnectionsSM Health
Management Program | Disease/condition management
that offers eligible members 24/7/365 access to a Health Coach by calling
1-888-YOUR-AH1
(1-888-968-7241) | Program administered by a third-party company | Program administered by AmeriHealth Health Coaches and will be
referred to as condition management |
| Case management | Provides members with extra support when dealing with an acute
illness, chronic condition, or multiple comorbidities | Support provided by AmeriHealth care management nurses | Support continues to be provided by AmeriHealth nurses, who are
called Health Coaches |
Benefits of the Primary Health Coach model include:
- The Health Coach remains consistent as a member transitions across the
health care continuum. This consistency ensures patient-centered coaching that
is individualized and coordinated.
- The Health Coach and member can develop a trusted relationship, which
fosters higher levels of member engagement and helps members reach their health
goals.
- A Health Coach will have a 360-degree view of a member?s complete health
record using an integrated nurse dashboard, which puts information at the
Health Coach?s fingertips. This display features information about the member?s
condition, prescription drugs, recent diagnostic or therapeutic activities, and
patterns of treatment and procedures. Such complete data review allows our
Health Coaches to have a more meaningful interaction with a member and improves
the customer experience.
What providers need to know
As of January 1, 2016, providers should refer all AmeriHealth New Jersey
members for disease/condition and case management by submitting an online
physician referral form. Providers who wish to
refer their patients via telephone should call 1-888-YOUR-AH1
(1-888-968-7241).
Note: Providers should no longer call the Provider Support Line
(1-866-866-4694) to make patient referrals for AmeriHealth New
Jersey members.
What AmeriHealth New Jersey members need to
know
AmeriHealth New Jersey members who use the disease/condition management
program and who have a Health Coach under the current program will be
transitioned to a new AmeriHealth Health Coach. Members who have three or more
Health Coach interactions between August 15 and November 1 will be notified of
this change by mail and assigned to a new AmeriHealth Health Coach.
Members should continue to call the same number (1-888-YOUR-AH1
) to reach a Health Coach. Once they indicate that they would like to
speak to a Health Coach, their call will be routed to a Health Coach at
AmeriHealth. Members continue to have 24/7/365 access to a Health Coach and
online educational tools.
If you or one of your AmeriHealth New Jersey patients has any questions
about this change, please call Customer Service at
1-888-YOUR-AH1
(1-888-968-7241).
|