Avera Health Care Management
- Physician Directed
- Health Coach Supported
- Patient Empowered
Care Management allows members and providers to focus on what matters most - getting well and staying well. A team of nurses, led by our 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 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.
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 Disease Management
The Asthma Program uses high-intensity interventions to improve the health of Avera Health Plans members diagnosed with asthma who are at high risk for adverse outcomes.
The Asthma Program utilizes health coaches to educate and support members to follow their doctor’s plan of care. Members participate in health coaching sessions by telephone. The frequency of the health coach/member interaction is dependent upon the severity of the member’s condition and their willingness to change. Members are provided educational materials and resources in a variety of media.
Disease Management activities are built on evidence-based, scientifically validated principles and nationally recognized standards.
Program Goals
Through quality education and support, we strive to increase medication compliance, promote use of an asthma action plan and peak-flow monitoring, decrease emergency room visits and inpatient hospital admissions and improve the health and lives of our members.
Participant Identification
The Asthma Program is available to most Avera Health Plans members, both children and adults, who have been diagnosed with asthma or reactive airway disease. Potential members are identified using a combination of Predictive Modeling, Health Risk Assessments (HRA) and assessment of readiness to change. We also encourage and welcome health care provider referrals into the program.
Diabetes Management
Overview
The Diabetes Program uses high-intensity interventions to improve the health of Avera Health Plans members diagnosed with diabetes who are at high risk for adverse outcomes.
The Diabetes Program utilizes health coaches to educate and support members to follow their doctor’s plan of care. Members participate in health coaching sessions by telephone. The frequency of the health coach/member interaction is dependent upon the severity of the member’s condition and their willingness to change. Members are provided educational materials and resources in a variety of media.
Disease Management activities are built on evidence-based, scientifically validated principles and nationally recognized standards.
Program Goals
Through quality education and support, we strive to increase treatment plan compliance, increase blood sugar control and preventive screenings for complications, decrease emergency room visits and inpatient hospital admissions and improve the health and lives of our members.
Participant Identification
The Diabetes Program is available to both children and adults, who have been diagnosed with diabetes. Potential members are identified using a combination of Predictive Modeling, Health Risk Assessments (HRA), and assessment of readiness to change. We also encourage and welcome health care provider referrals into the program.
Healthy Pregnancy and Healthy Baby Program
Overview
We provide high-intensity interventions to support Avera Health Plans members who are at increased risk for adverse outcomes during pregnancy. In addition, we provide a screening intervention to determine risk as well as support and educational materials to those members with healthy pregnancies and low risk of adverse outcomes.
The program provides targeted interventions aimed at increasing the enrollee’s knowledge about pregnancy, risk factors, signs of pre-term labor and complications. The program supports members by providing them with customized information focused on self-management skills and building a support network.
Program activities are built on evidence-based, scientifically validated principles and nationally recognized standards.
Program Participation
This program is available to most pregnant members. Members self-enroll in the program by clicking on Member Login and going to "My Benefits - Available Wellness Programs link." We also encourage and welcome health care provider referrals into the program.
Healthy Heart Disease Management
Overview
The Healthy Heart Program uses high-intensity interventions to improve the health of our members diagnosed with coronary artery disease or cardiovascular risk factors who are at high risk for adverse outcomes.
The program utilizes health coaches to educate and support members to follow their doctor’s plan of care. Members participate in health coaching sessions by telephone. The frequency of the health coach/member interaction is dependent upon the severity of the member’s condition and willingness to change. Members are provided educational materials and resources in a variety of media.
Activities are built on evidence-based, scientifically validated principles and nationally recognized standards.
Program Goals
Through quality education and support, we strive to increase medication compliance, promote use of a chest pain action plan, decrease emergency room visits and inpatient hospital admissions and improve the health and lives of our members.
Participant Identification
The Healthy Heart Program is available to most members 35 years of age and older. Potential members are identified using a combination of Predictive Modeling, Health Risk Assessments and assessment of readiness to change. We also encourage and welcome health care provider referrals into the program.
Healthy Living Program
Overview
The Healthy Living Program provides interventions to improve the health of our members who are overweight or obese.
The program utilizes specially trained health coaches to educate and support members in making healthy lifestyle choices in an effort to lose weight. Members participate in health coaching sessions by telephone and may communicate with their health coach via e-mail or postal mail. The frequency of health coach/member interaction is dependent upon the member’s co-morbities, recommended weight loss and their readiness to change. Members are provided support resources and educational materials in a variety of media.
Healthy Living Program activities are built on evidence-based, scientifically validated principles and nationally recognized standards, including but not limited to, Institute for Clinical Systems Improvement, National Heart Lung Blood Institute and American Medical Association.
Program Goals
Through support, goal-setting activities and education, we strive to assist members in adopting healthy lifestyle changes, incorporating physical exercise into their lives a minimum of 2-3 times per week and losing weight.
Program Participation
The Healthy Living Program is available to most members. Members self-enroll in the program. We also encourage and welcome health care provider referrals into the program.
