Services:
We offer a full range of engagement services on a stand-alone or integrated basis:

  • Utilization Management
  • Case Management
  • Disease Intervention
  • Patient Advocacy (Transparent Pricing)
  • Audits & Negotiations

 

Utilization Management:

  • The 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
  • Closely 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
  • Access to AHG’s external panel of medical specialists

 

Case Management:

  • Services provided by RN Case Managers with a variety of experiences and certifications in care coordination
  • Collaborate 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
  • 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: Asthma, Chronic Obstructive Pulmonary Diseases, Diabetes, End-Stage Renal Disease, Heart Disease, Heart Failure, Hyperlipidemia, hypertension, and low back conditions
  • Incorporates predictive modeling tools
  • RN Nurse Coaches provide for condition specific and web-based education links
  • Joint care planning with the member, physician, and RN Case Manager

 

Patient Advocacy (Transparent Pricing):

  • Our Web-Based Transparent Pricing tool affords AHG members the ability to determine prices for health care services( i.e. surgery, outpatient procedures), provider quality ratings, and secure PPO providers
  • Our Transparency Tool is incorporated into AHG's proprietary information system to enable patient advocates and RN Case Manager's to educate members and learn to shop for high value healthcare
  • Our Transparency software is user friendly and offers members access to provider pricing via PC's, tablets, and smart phones
  • With our Transparency tool, we successfully increase member engagement, improve health status, and medical expenditures.

 

 Audits & Negotiations:

  • Evidenced-based audits of provider charges or overpayment
  • Negotiations with providers for lower in-network and out-of-network payments

This service may be executed either before treatment is rendered or as a benefit application decision within the claims payment process on a retrospective basis. This is the assessment of patient care services, which have been determined to be questionable in the claims process. These services are provided telephonically and use AHG system, Internet, Microsoft Office Suite, email, and fax machines.

 

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.