Health Care Solutions

Health Insurance Solutions for Quality Health Care

Welcome to Our Integrated Model of Care

We’ve spent more than 40 years serving Medicaid and Children's Health Insurance Program (CHIP) populations. Our state-of-the-art care management models and award-winning wellness programs remove barriers to care and get people the help they need. Our holistic approach manages physical health, pharmacy, and behavioral health needs.

That’s our Next Generation Model of Care — one that focuses on the whole person.

It’s the foundation for how we operate, innovate, and continuously improve our services across the nation. It’s the basis of our specialization in providing outcomes-driven care and customized services for health plans, states, and other systems that manage care for publicly-funded programs.

We take pride in our expertise in the managed care market, and we’re here to help you navigate the health care system and comply with the rules and regulations specific to your state’s needs. View our solutions to learn more, or contact us today.

Quality services for health plans and states

Community-based care coordination in action

When members’ needs are not met through traditional health care delivery and care coordination, we offer community-based care coordination. A team consisting of a nurse, social worker, and community health worker — overseen by a medical director — connects with members in person to coordinate care and coach them on disease management. Through June 2017, across all lines of business, the outcomes are staggering:

50 percent

reduction in inpatient admissions per member, per year.

19 percent

reduction on total cost for members who had high use prior to the program.

36 percent

reduction in ER use.

The AmeriHealth Caritas difference

Through our Next Generation Model of Care, we are:

  • Focusing on our members’ illnesses and experiences — with health care and their environment — and supporting their caregivers.
  • Coordinating health outreach programs that deliver care locally through health information, classes, screenings, and other community-based clinical services.
  • Emphasizing growth and innovation, which will help shape our role in the communities we serve.
  • Supporting members’ needs for suitable and healthy housing, access to fresh food, transportation, and job training — in a true population health model, based on all of the social determinants of health.
  • Finding new ways to keep members out of nursing homes or help them overcome some of the challenges of intellectual and/or developmental disabilities, so that they can live independent lives.
  • Working with the industry’s top experts to drive a process of continuous renewal and performance excellence.