Services:
We offer a full range of engagement services on a stand-alone or integrated basis customized to meet your specific needs:

  • Utilization Management
  • Case Management
  • Disease Intervention
  • Patient Advocacy
  • Audits & Negotiations

 

Utilization Management:

  • Full range of pre-certification for inpatient, outpatient, diagnostic testing, post-acute care services and DME. You have the ability select the services to best meet your member population
  • In-network steering begins at this point of entry
  • Monitors post-acute transitions in care to assure safety, quality, and that the right amount of care is provided at the right time, the right place, at the right cost
  • Infusion site steering

 

Case Management:

  • Services provided by RN Case Managers with a variety of experiences and certifications in case management
  • Collaborative process of assessment, planning, facilitation, coordination, and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote high-quality and cost-effective outcomes
  • Expansive web and computer based member health education
  • Referrals to no cost community resources to meet medical and social needs
  • Individualized and member-centered case management plans of care and goals jointly developed
  • Communication and guidance for members to achieve case management goals and return to work quickly

 

Disease Intervention:

  • Education for members at high-risk of disability progression and high-cost care. Needs determined by the client. Typical program conditions: Asthma, Diabetes, and Heart Disease
  • RN Nurse Coaches provide condition specific and web-based education links
  • Joint care planning with the member, physician, and RN Case Manager

 

Patient Advocacy:

  • Transforms members into well-educated and accountable health care partners
  • Navigates health care system including locating the most cost-effective, high-quality PPO providers
  • Educates on health benefits and cost minimization
  • Prepares members for physician office visits

 

Audits & Negotiations:

  • Evidenced-based audits of provider charges or overpayment
  • Single case agreements (SCA) with out of network facilities and providers produce favorable results

 

Information Technology:

All services are integrated through a proprietary technology platform developed by AHG. The technology platform supports electronic linkages with employees and customers; merges clinical, claims and other financial information into AHG’s data warehouse; tracks AHG performance by client; and produces client outcome reports. The IT system and tools have been customized over many years and tailored to meet the needs of all AHG clients.