Leaders in Quality Care
AmeriHealth Caritas has helped low-income and chronically ill populations since our inception in 1983.
Today, we are:
- One of the largest Medicaid managed care organizations in the United States. We touch the lives of millions of people through a philosophy of care that is comprehensive, compassionate, and outcomes driven.
- Improving the stability and predictability of Medicaid spending while sustaining quality health outcomes. We have a proven track record of prioritizing preventive care, and reducing costly emergency room (ER) visits and hospital admissions. We also offer unique incentive programs that reward our providers for timely, efficient care and positive patient outcomes.
- Helping patients better manage their diseases and stay healthy through a person-centered approach that addresses members’ medical, behavioral, social, and medication needs. Additionally, our comprehensive health outreach programs deliver care locally through health information classes, screenings, and other community-based care management services.
Leaders in quality outcomes
We have more than 40 years of experience working with states to develop health care solutions tailored to our members’ special needs. These solutions have a successful track record of improving health outcomes and reducing preventable hospital admissions:
- Approximately $2.5 million in annual savings.
Our Keystone First health plan embedded nurses at high-volume hospitals to coordinate care for our members admitted to the ER or for inpatient care. Adding medical and medication costs together, the initiative decreased total costs by 3.9 percent, or approximately $2.5 million in annual savings.
- Up to 15 percent decrease in non-emergent ER visits and 911 calls.
Across all of our health plans, between 6 percent and 15 percent of members who believed they were having a medical emergency and first called our 24/7 Nurse Call Line had their health care concerns addressed without a visit to the ER or a 911 call.
- 100 percent reduction rate for missed prescription refills.
Medication nonadherence hurts members’ health and costs the health care system approximately $290 billion each year.1 Since 2016, our Medication Made Easy program has provided AmeriHealth Caritas DC members with reminders, pill-adherence packaging and organization, medication education, and home delivery to keep them on track — reducing missed refills in DC by 100 percent.
- 11.5 percent decrease in 30-day readmissions for members with chronic conditions.
In 2014, we tackled 30-day readmission rates for members with dominant chronic conditions or asthma. We strengthened discharge planning processes, increased outreach to our members, and partnered locally to customize an approach specific for that health plan’s members and providers.
Cost saving care
Medicaid managed care saves money
$5.9 billionsaved in Pennsylvania state and federal funds.
$3.5 billionprojected additional savings for Pennsylvania through 2020.
Evidence-based, coordinated managed care models like ours help maximize cost savings while delivering quality health care. As such, they have become a priority for state and federal policymakers.
For example, a 2011 report by the Lewin Group reveals how AmeriHealth Caritas health plans are among the managed care groups that have saved Pennsylvania as much as $5.9 billion in state and federal funds since 2000. What's more, these plans are projected to save the state another $3.5 billion through 2020.
With our expertise in integrated managed health care plans, preventive care, and community-based services, we are well positioned to help your government health agencies find the value you need.
Addressing “super-utilizers”: decreasing inpatient admissions by 25 percent
In 2014, our Keystone First health plan set out to address “super-utilizer” or "high-utilizer" members, most of whom have both medical and behavioral health needs and face significant barriers to care. Our staff used in-person interaction, such as home visits, to assist members in overcoming those barriers and to connect them with their behavioral health managed care organization. Following our successful pilot, we integrated this program into all of our health plans.
- Improved adherence to treatment plans.
- Better clinical outcomes.
- Decrease in unnecessary care expenditures.
- 25 percent or higher decrease in inpatient admissions per member per year.
To help battle health disparities and ever-inflating health care costs, we’re always looking for new ways to bring superior care to our members, offer superior support to our providers, and provide cost-effective solutions for our government partners.
Reaffirming our commitment to our members:
- Our partnership with former University of South Carolina football star Marcus Lattimore’s youth football camp encouraged good health, strong values, and preventive care.
- We ensured better access to opioid addiction treatment in Washington, D.C., and opened a treatment center in Philadelphia through a partnership with CleanSlate Centers, a national leader in addiction treatment.
- Our collaboration with Vheda Health helped set up remote biometric monitoring for Florida and Louisiana members with diabetes or congestive heart failure.
- Medication Adherence in America: A National Report. The National Report Card on Adherence. Alexandria, VA: National Community Pharmacists Association, 2013.