AmeriChoice MSO Wins Care Management Contract in Washington

The AmeriChoice Management Services Organization (MSO) has been awarded a contract by the Washington State Department of Social and Health Services to provide chronic care management services to about 60,000 Aged, Blind and Disabled (ABD) Medicaid beneficiaries in a new statewide program.

Key to the program is the unique AmeriChoice Personal Care Model™, which features both advanced health care management technology and direct client contact by AmeriChoice clinicians trained to foster an ongoing relationship between the Washington Chronic Care Management Program, AmeriChoice clinical staff and clients suffering from serious and chronic conditions, said Dr. Ashish Abraham, AmeriChoice Senior Vice President for MSO Programs and Health Strategies.

“These personalized care programs are designed to help clients avoid hospitalizations and hospital emergency room visits. The goal is to use high quality health care and practical solutions to improve clients’ health and keep them in their communities, with the resources necessary to maintain the highest possible functional status—in short, to help them live healthy, productive lives,” Dr. Abraham said.

AmeriChoice will use Impact Pro, a sophisticated predictive modeling software from Ingenix, like AmeriChoice, a unit of UnitedHealth Group, to identify each client’s specific health care needs and gaps in their care by analyzing health care claims data against databases that incorporate the latest in evidence based medicine concepts. Nurses and social workers then work as a team to address the member’s medical, psychosocial, and environmental needs in an integrated, comprehensive care model incorporating both primary and specialty care and services. Community organizations and other local supports are also brought into the picture, if appropriate.

“This model has been successful in improving the quality of care at less cost in other states across the country,” said David Kreiling, Director of Business Development for AmeriChoice MSO. “Moreover, it is an evolutionary step forward from the disease management program Washington has had in place since 2002.” Unlike traditional disease management programs, which focus on specific conditions, the AmeriChoice Personal Care Model is designed to support Washington’s broader programmatic goals by targeting the highest risk, medically vulnerable population.

The AmeriChoice contract, which is for a two year period beginning January 1, 2007, covers the entire state except for King County (Seattle), where the King County Local Care Management Services, which operates within Seattle Aging and Disability Services, will take clients identified as highest risk by AmeriChoice and provide case management and “medical home” infrastructure services for them. Kreiling said that AmeriChoice will open an office in Seattle by January, 2007 and anticipates hiring a leadership team, registered nurses, licensed clinical social workers, and outreach staff to work on-site and in the community.