Our Focus in Health Care
The following services are available to promote health and well being through education, collaboration and support.
Care Management
Disease Management
Care Management
Care Management allows members and providers to focus on what matters most — getting well and staying well! A team of nurses, led by AHP’s Chief Medical Officer, works together with you to meet your healthcare needs. Care coordination builds relationships that enable us to make a difference in the lives of the individuals we serve.
What do they do?
- Serve as a community link and source of information among you, your providers and Avera Health Plans.
- Support and assist in locating services, providers, and facilities within our network.
- Direct you toward appropriate resources to best support individual health and wellness needs including referral to formal Disease Management and Healthy Living Programs.
- Advocate for you to assure your health care needs are met.
- Assist with acquiring durable medical equipment in your community.
- Offer help with Avera Heath Plans drug formulary to promote generic medication use.
Care Management is available at no additional charge to:
- Members with known, or who are at risk for, chronic illness
- Members facing issues in accessing health care or following a prescribed course of treatment.
- Members interested in maintaining healthy lifestyles.
- New members to Avera Health Plans.
Who can benefit?
- Members with known or those predisposed to chronic illness.
- Members noncompliant with medications or treatment plans.
- Members with barriers to care, such as assistance in locating community services near members’ homes, transportation to appointments, meals-on-wheels, support groups and many other services.
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Disease Management
The Disease Management support programs have demonstrated success in improving clinical outcomes, increasing self-management of chronic medical conditions and increasing satisfaction for both members and providers. Those we coach, educate and support through our disease specific support programs do better, feel better and report a higher quality of life.
Support Program Options:
- Asthma
- Coronary Artery Disease
- Diabetes
- Hey Baby (maternity)
- Healthy Living (weight management and obesity)
Program Objectives:
- Improve population health
- Encourage use of best practice guidelines
- Achieve positive patient outcomes
- Reduce impact of chronic disease
Desired Outcomes:
- Healthy behaviors
- Improved clinical performance
- Member and provider satisfaction
- Optimal utilization and patient responsibility
- Improved financial performance for employers
Program standards support best practices based on appropriate professional organization standards.
Our support programs provide an approach using high intensity interventions for improving the health and status of our members diagnosed with select chronic disease states that may lead to adverse outcomes. Specially qualified to manage and monitor chronically ill patients, our Health Coaches offer valuable support.
Members eligible for a support program are identified using a combination of predictive modeling, health risk assessments, and assessment of readiness to change. Our industry-recognized application of key behavior change principles, integrated in our support system, ensures that each intervention is based on individual levels of confidence. Incentive-based models may be used to encourage participation.
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