Condition and Case Management

Condition Management

Modern medicine allows doctors to offer you a variety of options for your care. The trick is to figure out what makes sense for you. And that’s what the condition management program is all about.

In addition to offering access to Health Coaches, condition management provides you with resources that can help you get the information and support you need to make the health decisions that are right for you.*

Condition management provides resources and support for the following:

  • asthma
  • coronary artery disease (CAD)
  • chronic kidney disease
  • chronic obstructive pulmonary disease (COPD)
  • diabetes
  • heart failure
  • high risk pregnancy
  • HIV
  • hyperlipidemia
  • hypertension
  • inflammatory bowel disease
  • Maternity Management
  • metabolic syndrome
  • musculoskeletal pain
  • migraine
  • obesity
  • osteoporosis
  • upper gastrointestinal disease

Case Management

Case management is a collaborative process that provides members with health management support through a variety of coordinated programs. It is offered as a confidential and free program to members with our health coverage who are experiencing complex health issues or challenges in meeting their health care goals.

Case management is an ongoing process of working with members, their families, health care providers, and community resources. Health Coaches work step by step to:

  • Identify members who could benefit from case management and contact them via telephone.
  • Assess the member’s current health status and history by asking various health-related questions.
  • Confirm if the member has case management needs and explain how AmeriHealth's case management programs can assist a member in managing his or her health.
  • Develop a care plan designed to meet the specific needs of the individual member. The Health Coach may utilize home care or educate and coach the member on lifestyle changes to support independent health management.
  • Follow up with the member, his or her family, and physician at the specific intervals (e.g., weekly, monthly) to review and enact the plan until all goals are met or case management services are no longer appropriate.
  • Discharge the member from case management once all identified needs have been adequately met and goals achieved or when case management services are no longer appropriate. Members can continue to contact the Health Coach at any time.

A Health Coach is available to help you with your complex needs. If you feel you may benefit from this program, please call a Health Coach at 1-888-YOUR-AH1 (1-888-968-7241).

Case Management FAQ

Who are Health Coaches, and what do they do?

Nurses and social workers work as Health Coaches. They work with you over the telephone to educate, help, and support you.

How can I benefit from case management?

Health Coaches provide you with information and direction about health issues, health coverage, available community resources, such as help with transportation, and much more. They can help make sure you are getting the best use of the covered services available to you.

How do I find my Health Coach, or does my Health Coach find me?

A Health Coach may contact you by telephone or letter following a hospital or rehabilitation stay. Alternatively, if you need to talk to a health professional about a health-related issue or have health care needs and require assistance, you can contact a Health Coach yourself. Call 1-888-YOUR-AH1 (1-888-968-7241), and leave a message. A Health Coach will return your call as soon as possible.

* Condition Management is available at no cost to most members. Please refer to your member materials for the terms, limitations, and exclusions of your health care coverage, or call Customer Service at the number on the back of your medical ID card to find out if you are eligible.