AmeriHealth has introduced a new approach to health coaching for our Pennsylvania members, called the Primary Health Coach model. The new 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).

The following table describes our former care management programs and the changes that have been made for Pennsylvania members as a result of this transition to the Primary Health Coach model:

Fully insured Pennsylvania members transition to the new Primary Health Coach model on May 6, 2013, and Pennsylvania members from self-insured groups will transition on January 1, 2014.

Benefits of a Primary Health Coach model include:

• The Health Coach remains consistent as members transition 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

Providers should now refer Pennsylvania members for disease/condition and case management by submitting an online physician referral form. A link to this form is also available on NaviNet? Plan Central in the Administrative Tools & Resources section. Providers who wish to refer their patients via telephone should call 1-800-275-2583.

Note: Providers should no longer call the Provider Support Line (1-866-866-4694) to make patient referrals for Pennsylvania members.

The ConnectionsSM Provider Portal has been discontinued, and providers will no longer receive the SMART? Registry. Instead, providers continue to have access to similar information for their patients through our Clinical Alerts and the Clinical Care Report, both available on the NaviNet web portal through the Eligibility and Benefits Inquiry transaction.

Please note that, with the discontinuation of the SMART Registry, the SMART Registry CD Access Code transaction will be removed from NaviNet later this year.

What Pennsylvania members need to know

Pennsylvania members who currently use the disease/condition management program and who have a Health Coach under the current program have been transitioned to a new Health Coach at AmeriHealth. These members were notified of this change by mail and were assigned to a new AmeriHealth Health Coach.

Members should continue to call the same number (1-800-275-2583) 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 patients in Pennsylvania has any questions about this change, please call Customer Service at 1-800-275-2583.

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