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Disease Management program receives great feedback from participants

October 6, 2015 — American Health recently completed its annual Disease Management (DM) participant survey and again received great results:

  • 97.8% overall member satisfaction
  • 89% agree that DM teaches them better ways to manage their health condition
  • 97% say that their nurse coach demonstrates that they are knowledgeable
  • 96% say their nurse health coach explains things in a way they can understand

 

In addition, 100% of American Health clients in our 2015 client satisfaction survey said that our Disease Management program exceeds or meets their expectations. 

One Disease Management participant said: “This program and the nurse I get to talk with have completely changed how I manage my diabetes. She gives me suggestions and informs me about the medication I am taking. I look forward to sharing my progress with her.”

Our clients have spoken, and 98% are satisfied with our programs and services

Sept. 18, 2015 — American Health recently completed our biennial client satisfaction survey, which was administered by independent consultant Saperstein Associates and fulfills the requirements of our URAC accreditation. We are thrilled to announce the excellent results. In addition to a 98% overall satisfaction rating, our clients have the following impressions of our service:

  • 97% would recommend American Health
  • 100% believe staff is well-trained and knowledgeable
  • 99% say that our services are a good value
  • 97% believe that American Health is innovative

 

We also received positive feedback on individual services, with the following percentages of clients saying that our programs exceed or meet their expectations:

  • Utilization Management: 97%
  • Case Management: 98%
  • Disease Management: 100%
  • Reporting: 91%

 

For an overview of our 2015 results and more information, including a video of our President & CEO Paul Lavin discussing client satisfaction, visit the Client Satisfaction Survey page of our website.

Medical Transportation team reaches milestone 1,000 cases managed

When members need transportation for care, American Health's Medical Transportation service provides coordination to help your plan save.

Since the program began in 2007, the team has managed over 1,000 cases spanning the globe.

Medical Transportation isn’t just for an emergency. Our team of experienced clinical care coordinators can help with all types of transportation for care, whether it’s across town or across the globe.

The Medical Transportation team is knowledgeable in the complex activities associated with these transportations, including verification of benefits, coordinating with facilities and transportation carriers, and travel document assistance. Plus we achieve savings for plans through negotiations and relationships with carriers.

Below are more details on the transportation services we offer.

Emergency air ambulance
Transportation in an emergency or for members who need to travel long distances. Provided to members who are in a location that cannot provide the necessary care, or who have a serious illness or injury while traveling and need to be transported closer to home.

Complex ground transport
Provided when members need to be transported shorter distances, the member is in a remote area, or air transport is not possible due to inclement weather.

Medical escort
For members who are medically stable and able to travel on a commercial carrier. Our team books the flight, including medical clearance and arranging for priority boarding and seating. A clinically experienced medical escort travels with the member to monitor them and assist with care such as oxygen and medications.

Commercial travel assistance
For stable members who can fly commercial without an escort. We arrange boarding, seating and transportation to and from airport

Transplant patient transport
Planned transportation for members who are on a transplant list and need to travel a significant distance on short notice to receive their transplant.

Bariatric coach transport
Coordination for bariatric coaches, which include custom equipment to support members unable to travel by ambulance, commercial carrier or air ambulance.

Repatriation services
Assistance to families of a deceased member in transporting the member back to the home country or state.

Only four months until the transition to ICD-10 codes. Is your medical management provider ready?

The mandated transition from ICD-9 to ICD-10 diagnosis codes on October 1, 2015, is fast approaching. If your medical management provider isn’t prepared for the change, your services could be in jeopardy.

American Health has been preparing for this transition since 2012 and has evaluated every client and system impacted, our reports, client rules and how clients can take advantage of the increased specificity of ICD-10 codes. We’ve completed planning, gap analysis and system remediation. We are currently working with clients on testing and are training our staff.

As of July 1, 2015, American Health will be prepared to accept ICD-10 diagnosis codes for dates of service on or after October 1, 2015. We will also continue to accept ICD-9 codes for one year.

Learn more about how we've prepared for ICD-10.

Medical management that supports stop loss

Our goal as a leading medical management company is to ensure our clients' members are receiving quality care while containing costs. To accomplish this, we work closely with our clients’ stop loss carriers. Our systems and process are flexible, allowing us to work with any carrier. In addition, American Health has preferred status with approximately 50 stop loss carriers who provide discounts up to 12 percent.

 

System access and reporting

With clients’ permission, American Health can provide stop loss carriers with access to our iSuite system, which allows them to search for member history or a particular case. Access can be customized down to the group level.

Through iSuite, carriers also have direct access to EZ Reports, which provides electronic on-demand and scheduled reporting. Our detailed reports include information on certification activity and extended length of stay within Utilization Management, referrals to Case Management, as well as Case Management cases and clinical information.

American Health also provides the ability to consolidate reports to support the stop loss renewal process. This reduces the amount of time to gather clinical information for stop loss renewal applications.

American Health's Outpatient UM program helps clients maximize savings

If you’re not precertifying outpatient services, you could be missing huge savings.

Most health plans with utilization management require precertification for inpatient services. But with more and more medical procedures, tests and treatments taking place in outpatient settings, ignoring outpatient services could be costing you.

American Health offers convenient and cost-effective bundled options for Outpatient Utilization Management:

  • Surgery
  • Diagnostic services (includes Advanced Radiology Scheduling Services)
  • Continuing care (includes oncology and dialysis)
  • Psychiatric and substance abuse

 

We provide expert guidance in designing precertification requirements and have the ability to customize rules that maximize network utilization. Reviews are performed by experienced registered nurses using care guidelines from MCG Health to determine medical necessity and appropriate level of care. Our UM services include precertification, concurrent review and discharge planning.

American Health provides added flexibility in our UM program with a precertification website, which allows providers to begin the precert process online. Providers can still request a precert by phone, and the precertification website is available in our UM program at no cost.

ROI for Outpatient UM is 4.9 to 1 and also provides additional opportunities for Case Management savings. Cases that may be complex, long term or costly are automatically referred to Case Management through our proprietary iSuite system or manually referred based on our UM nurses’ judgment.

Watch our president, Paul Lavin, explain how UM is different at American Health.

American Health receives URAC accreditation through 2017

September 3, 2014

American Health is proud to announce that it has received URAC accreditation for Health Utilization Management, Case Management and Disease Management through October 1, 2017.

URAC is an independent, nonprofit healthcare accrediting organization dedicated to promoting healthcare quality through accreditation, education and measurement. URAC accreditation requires applicants to submit policies, procedures and other organizational information to URAC followed by an onsite review.

“URAC is highly respected in the healthcare industry, and accreditation represents a distinction of quality,” said Paul Lavin, president and CEO of American Health. “We are thrilled to continue our strong history of URAC accreditation.”

American Health has been URAC accredited in Health Utilization Management since 1994, in Case Management since 1999 and in Disease Management since 2005.

“American Health Holding should be commended for meeting strict quality standards,” said URAC President and CEO Kylanne Green. “It is critically important for healthcare organizations to make a commitment to quality and accountability. URAC accreditation is a demonstration of that commitment.”

American Health adds chronic kidney disease to Disease Management

November 13, 2013

As an enhancement to Disease Management, American Health announced it has added chronic kidney disease (CKD) as the ninth condition to its program. The company will begin identifying and opening case referrals for CKD in December 2013.

Adding CKD expands the reach of American Health’s Disease Management to additional members, improving its ability to impact member health and claims costs.

“The addition of chronic kidney disease to our Disease Management program is another way that American Health is improving our service to our clients and members,” said Paul Lavin, president of American Health. “This is part of our ongoing effort to find ways to add value without adding cost to our clients.”

Affecting more than 26 million adults in the U.S.1, CKD costs on average $23,000 per patient per year2. CKD can cause complications including high blood pressure, anemia, weak bones, nerve damage and heart disease. By managing CKD, patients can prevent or delay the onset of kidney failure, for which the only treatments are dialysis or kidney transplant.1

“Chronic kidney disease is a condition that can cause significant complications if not controlled,” said Donna Todd, RN, senior director, clinical operations at American Health. “Our nurses make an impact by providing an additional resource to members for health management, helping them avoid complications that could potentially lead to difficult, costly procedures such as dialysis and transplant.”

American Health’s Disease Management nurse health coaches use clinically proven, evidence-based tools to help members manage their condition and avoid future complications. The following conditions are included in American Health’s programs:

  • Asthma (pediatric and adult)
  • Chronic kidney disease (CKD)
  • Chronic obstructive pulmonary disease (COPD)
  • Chronic pain (from osteoarthritis, rheumatoid arthritis or low-back pain)
  • Congestive heart failure (CHF)
  • Coronary artery disease (CAD)
  • Diabetes (pediatric and adult)
  • Hyperlipidemia (high cholesterol)
  • Hypertension (high blood pressure)

 

1The National Kidney Foundation; www.kidney.org

2United State Renal Data System; www.usrds.org

American Health case managers and nurse health coaches earn URAC "Health Care Stars!" nominations

September 30, 2013

American Health is proud to announce that 12 case managers and 6 Disease Management nurse health coaches have been nominated for URAC’s 2013 “Health Care Stars!” Awards. These American Health staff members make up 18 of the 42 nominees nationwide. URAC’s “Health Care Stars!” Awards Program honors those health care professionals who directly impact the lives of consumers they serve.

“We are thrilled that the incredible achievements of our case managers and nurse health coaches have been nominated for recognition from URAC, the leader in promoting health care quality,” said Paul Lavin, President & CEO of American Health. “Our registered nurses and licensed social workers make personal connections with members every day to ensure they receive the best care and achieve the best outcomes possible. The fact that our staff comprises nearly half of the nominations for the ‘Health Care Stars!’ Awards shows that we are leading the industry in quality and outcomes.”

American Health’s case managers are clinical experts who impact the health of members by providing education, support and care coordination during difficult injuries or illnesses, such as oncology treatments, transplants and high-risk pregnancies. Click here to learn more about American Health’s Case Management program.

Disease management nurse health coaches work with members who have been diagnosed with chronic conditions to help them understand and manage their condition. Nurse health coaches provide education on the member’s specific health issues, as well guidance on nutrition and exercise, and motivate members to set and achieve goals to improve their health. Click here to learn more about American Health’s Disease Management program.

American Health extends Population Health Management services to enhance member wellness resources

August 1, 2012 (Worthington, OH)

American Health Holding, Inc., a multi-URAC accredited medical management service provider, centers on member health by introducing the Performance-Based Wellness program through a partnership with Interactive Health. When Performance-Based Wellness is combined with American Health's existing Disease Management program, the services offer increased opportunities for member engagement and a viable solution for health care savings.

Performance-Based Wellness is a unique approach to wellness, designed to empower members to be accountable for their health. The program starts with health evaluations that include biometric testing and a health questionnaire. The comprehensive screenings detect a wide range of health concerns including cardiovascular disease, diabetes, liver and kidney disease, anemia and certain types of cancer.

Members who complete the health evaluation receive a comprehensive, personal health report that acts as a clinical benchmark of current health and suggests areas for improvement. The Performance-Based Wellness program assigns each participant a customized goal based on their health status and provides resources for members to achieve that goal and make ongoing efforts to improve their health.

When Performance-Based Wellness is combined with Disease Management, the programs provide members with awareness of their health status, comprehensive coaching options and a strong incentive design. This results in increased participation in the programs and improvements in member health. Significantly, 81% of participants in the Performance-Based Wellness program achieve their overall health goals.

Interactive Health statistics show that employers utilizing the Performance-Based Wellness program had 20% lower medical spend per member per month versus those without the program. Even greater results are achieved when the services are combined with Disease Management.

American Health and Interactive Health also offer a funding model that allows clients to utilize the current health plan and existing preventive benefits by billing the cost of both programs as a claim to the medical plan.

"American Health’s Disease Management and Interactive Health's Performance-Based Wellness are a unique combination that helps our clients address health care costs and improves member health and productivity," said Paul Lavin, president and CEO of American Health. "Our programs work together to address our common objectives, and combined we see greater member engagement."


Testimonials

  • AHH has added best practice clinical services, system, tools and people to our team and suite of services. Their flexible delivery of the client- and member-focused model, coupled with their proven performance and outcomes, puts AHH at the top of my list. AHH is an exemplary partner.
    Gregg Kamas
    Chief Health Officer

    EBMS, Inc. Greenwood Village, CO
  • The value that American Health brings to our clients and members is invaluable to our company. In a recent case, American Health coordinated the transfer of a plan member's daughter to a nearby hospital following a tragic accident. Relieving the burden of responsibility to the family while carefully managing costs is the type of service we can expect from American Health.
    Cindy Sonnen
    President

    Simplifi Health Benefit Management, LLC Columbus, OH
  • Wellness and Disease Management programs have been a hot topic for a few years, and clients are reaching out to discover ways to incorporate wellness into employee health plans effectively and efficiently. AHH has been instrumental in helping TPSC assist our clients with a variety of choices and excellent service. Developing a program of Utilization Management, Disease Management and Wellness can be challenging and exciting all at once! The staff at AHH has been very open to hearing the needs of our clients and assisting us in developing the program that serves each client's specific desires and requirements.
    Cindy Gibbons
    Account Manager

    Trusteed Plans Service Corporation Tacoma, WA
  • The reason we continue to use American Health is because we can rely on them for defensible and reasonable reviews of our non-contracting provider bills (out- of- network claims). We have come to find their services invaluable.
    Pauline Hann
    Benefits Manager

    Carpenters Health & Welfare Trust Fund for CA Oakland, CA
  • American Health is and has always been very receptive to any need that we may have in servicing our clients. Their products and services are constantly being updated to meet the changing needs of this market. I would highly recommend AHH to anyone needing medical management services.
    Deb Immel
    RN CMCN CCM