Health Care Solutions

Health insurance solutions for quality health care

We have served people enrolled in publicly funded health plans for over 40 years. Our state-of-the-art care management models and award-winning wellness programs remove barriers to care and connect people with needed services.

Our integrated whole-person approach supports the physical and behavioral health of our members, and addresses their social needs to create a tailored plan for each individual.

Our comprehensive, integrated strategy is the foundation of our operations, innovations, and continuous improvement of our services across the enterprise. It forms the foundation of our expertise in delivering outcomes-driven care and tailored services for health plans, states, and other systems overseeing 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 — supervised by a medical director — connects with members in person to coordinate care and coach them on disease management. Our focus on implementing best practices and continuously improving patient outcomes has produced consistent improvement in member support and outcomes. Recent accomplishments include:

45%

reduction in inpatient admissions per member, per year

48%

reduction in total cost per member

18%

reduction in ER use

The AmeriHealth Caritas difference

Through our whole-person care model, we are:

  • Prioritizing our members’ conditions and experiences and considering their health, equity, health care, and environment, while also supporting their caregivers
  • Coordinating health outreach programs that deliver care locally through culturally relevant health information, classes, screenings, and other community-based clinical services
  • Emphasizing growth and innovation, which play a crucial role in defining our impact within 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 industry experts to drive a comprehensive process of continuous renewal and performance excellence, informed by up-to-date information from routine program monitoring