Condition and case management

Case management

Helping you help your patients

Sometimes patients need extra support when they are dealing with an acute illness, a chronic condition, or multiple comorbidities. Often, they look to their treating providers for this additional support.

Case management can help

Registered Nurse Health Coaches (Health Coach) can collaborate with you to support and guide your patients through an acute or chronic episode to help achieve the medical treatment goals you have established.

Health Coaches

Educate patients about their disease, condition, or medication and offer resources to better understand how to manage their health.

• Help patients navigate the health care system.
• Refer patients to other Plan programs or benefits-related resources such as nutritional counseling or mental health services.
• Provide information on community resources.

If you are interested in having your patient work with a Health Coach, complete the AmeriHealth physician referral form or AmeriHealth New Jersey physician referral form or contact us by calling 1-800-313-8628.

Condition management program

Recognizing that the physician-patient relationship is at the heart of patient care, the condition management program is designed to help providers and their patients manage chronic conditions, support the providers’ relationships with their patients, and do the following:

• Enhance the provider’s ability to provide integrated care for their patients.
• Provide members with evidence-based information so they can understand their diagnoses and their health care options while actively participating in health care decisions with you.
• Promote integration of care among members and their family, physicians, Registered Nurse Health Coach (Health Coach), social workers, and community resources.

Health Coaches

Health Coaches offer condition management to all eligible members. Health Coaches help members work effectively with their physicians to make “shared decisions” that are right for them.

The best way to refer a patient for health coaching is to complete the AmeriHealth physician referral form. Providers can also call 1-800-313-8628 to make a patient referral.

Eligible members can speak with a Health Coach 24 hours a day, 7 days a week. AmeriHealth members may call 1-800-275-2583 (Pennsylvania) or 1-888-968-7241 (New Jersey).

Eligibility

Members who are covered through fully insured employer groups are automatically considered eligible for the condition management program. Members covered through certain self-insured employer groups may not be eligible for the program. Members can call Customer Service at the number on their Member ID card to verify their eligibility.

Provider rights and responsibilities

Our condition management program values the importance of the physician-patient relationship and is designed to enhance evidence-based care. The program is based on open and collaborative communication among the provider, his or her patient, and the Health Coach. We ask all participating providers to review their rights and responsibilities.

Integrated Behavioral Health Case Management

Behavioral Health Case Management provides members with extra support for their emotional well-being needs. Behavioral Health Case Managers specialize in a variety of areas including mental health and substance use. The goal of Behavioral Health Case Management is to help members set goals and connect with resources to support their comprehensive healthcare needs.

If you are interested in having your patient work with a Behavioral Health Case Manager, complete the AmeriHealth physician referral form or call 1-800-313-8628.

Members may access Behavioral Health Case Management services 24/7 by calling the number on the back of their ID card under Mental Health/Substance Abuse.

Eligibility

Members who are covered through fully insured employer groups are automatically considered eligible for Behavioral Health Case Management. Members covered through certain self-insured employer groups may not be eligible for the program. Members can call Customer Service at the number on their Member ID card to verify their eligibility.