Effective July 1, 2014, AmeriHealth New Jersey Medicare Advantage HMO members will transition to the Primary Health Coach model. The Primary Health Coach model is an updated approach to health coaching that 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).

Note: AmeriHealth New Jersey commercial members will continue to have their disease management services under the Connections^SM Health Management Program through Health Dialog.

The following table describes our former care management programs and the changes that will apply to AmeriHealth New Jersey Medicare Advantage HMO members as they transition to the Primary Health Coach model:

Program Program description Former program Changes for new model Connections^SM Health Management Program Disease/condition management that offers eligible members 24/7/365 access to a Health Coach by calling 1-800-275-2583 Program was administered by Health Dialog Program is administered by AmeriHealth Health Coaches Connections^SM Complex Care Management Program Supports eligible members who have one or more of 16 complex, chronic conditions Support was provided by AmeriHealth care management nurses Program name has been discontinued, but support continues to be provided by AmeriHealth Health Coaches Case management Provides members with extra support when dealing with an acute illness, chronic condition, or multiple comorbidities Support was provided by AmeriHealth care management nurses Support continues to be provided by AmeriHealth nurses, who are called Health Coaches

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 AmeriHealth New Jersey Medicare Advantage HMO patients for care management by submitting an online physician referral form. A link to the Forms page is also available on NaviNet^® Plan Central in the Administrative Tools & Resources section. Providers who wish to refer their patients by telephone should call 1-800-275-2583.

What members need to know

Members who currently use the disease/condition management program and who have a Health Coach under the current program will be 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 New Jersey Medicare Advantage HMO patients has any questions about this change, please call Customer Service at 1-866-569-5190.

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