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AmeriChoice MSO is uniquely positioned to offer tailored solutions and administrative services to State Medicaid programs. By combining our vast experience, state of the art technology, industry knowledge and best practice, AmeriChoice MSO offers a wide array of services to states aimed at reducing administrative burden, increasing programmatic efficiencies, increasing quality of care to members, while reducing overall costs. The services we offer to our customers and stakeholders can be grouped in four broad program categories::
Medicaid PCCM and Enhanced PCCM Program Administration
Medicaid Primary Care Case Management (PCCM) programs are increasingly being adapted and modified into models that place a stronger emphasis on measurable improvements in outcomes and cost savings. Expanded models use moderate levels of managed care techniques and best practices, while enhanced models use a more sophisticated and exhaustive array of care management methods. AmeriChoice MSO has been a pioneer in this field and has helped states develop and implement patient-centered, physician-directed, enhanced PCCM programs that improve quality and cost-efficiency of Medicaid services.
Our Enhanced PCCM programs blend the payment methodology and positive
features of the fee-for-service environment with the best practices
of full-risk managed care. EPCCM programs:
- Promote increased member choice for care services;
- Encourage strong physician-patient relationships and physician-directed
care; and
- Provide support to members and physicians through a variety of managed care tools and techniques, including, but not limited to:
- Member Services – call center, health education mailings,
social support services (transportation);
- Provider Services – network development, provider help lines, clinical guidelines, referral and coordination of care support, and
- Care Management Services – utilization management, high-intensity case management, population-based disease management.
- Enrollment Broker and Member Call-Center/Help-Line Services
- Financial and Claims Management Services on behalf of State PCCM programs
Enhanced Care Management and
Disease
Management Program Administration
Through the extensive experience gained in the operation of our health plans, AmeriChoice MSO brings a wealth of expertise in administering care and disease management programs in public sector health care environments. Currently AmeriChoice provides these care management services in 14 states across the nation both in the managed care and the fee-for-service program environments. Our management services approach to care and disease management is based upon certain core principles that ensure the provision of high quality, cost-effective services.
- Participant-Centric Focus: All AmeriChoice MSO staff at all levels
recognize the participant or the patient as our primary customer and
perform all activities with intent to improve the care experience, quality
of life and health outcomes of the patient population as a whole. Through
our activities we constantly seek to build personal relationships with
patients and earn their trust and confidence.
- Collaborative Provider Relationships: AmeriChoice strives to build
strong provider relations with primary care providers, specialists and
hospitals and seeks to equip them with the education and tools needed
to better serve their patients. Towards this end, we also ensure that
claims processing and payments are made quickly, accurately and with
minimum administrative burden to providers, further strengthening this
relationship.
- Condition-Appropriate
Utilization of Services in Appropriate Care Settings: Through
prior authorizations, referral mechanisms and inpatient utilization management
techniques, AmeriChoice works to ensure that limited health care
resources are used judiciously to benefit the greatest number of clients
and with optimal health outcomes.
- Coordination of Care for Select Patients with Chronic
Illnesses or with Intensive Needs: AmeriChoice uses case management,
disease management, care coordination and discharge planning
to facilitate appropriate access to care across the continuum of health
and health-related services and to ensure that care is provided in an
effective and efficient manner that maximizes positive health outcomes.
- Data and Information-Driven
Decision-Making: Throughout the organization we create and
maintain efficient and integrated information systems and generate reports
and information that drive the clinical and administrative decisions
we make. This information is provided not only to AmeriChoice staff but
also to our key stakeholders such as State/County governments, physicians
and patients.
Uninsured and Specialty Health Program Administration
Since 1983, AmeriChoice MSO has provided a comprehensive array
of health care management services for San Diego's County Medical
Services (CMS) program. The CMS program acts as a "safety net" for
uninsured individuals, including those who do not qualify for
Medi-Cal (California's Medicaid program). The target population faces
the same challenges as a Medicaid population in accessing high quality
and preventive health care.
Throughout this 21-year partnership we have worked collaboratively
with San Diego County, providers, recipients and other stakeholders
to create a delivery system that provides high quality care to
as many individuals as possible while maximizing the limited resources
that are available. The scope of our services has grown over time
to meet the changing needs of the County and the recipient population.
The specialty services that we now provide are:
- Disease management
and high-intensity case management services
- Medi-Cal (California
Medicaid) revenue recovery services
- Correctional care and management
services for the San Diego County Sheriff's
Department.
- HIV/AIDS Ryan White CARE Act program financial management, quality
reporting and other administrative services .
Strategic Health Care Consulting
- Performance Measurement and Data Analytics
- HIV/AIDS Consulting
- 340B Consulting
- MRDD Waiver Consulting
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