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Condition Management Program

Condition Management is designed to help providers and their patients manage chronic conditions, support the providers’ relationships with their patients, to enhance providers’ ability to provide evidence-based care, and to help patients make more informed decisions about certain significant medical conditions. Recognizing that the physician-patient relationship is at the heart of patient care, these programs have been designed to:

• enhance the provider’s ability to provide integrated care for their patients;
• provide members with evidence-based information so they can understand their diagnoses and their health care options, while actively participating in health care decisions with you;
• promote integration of care among members and their families, physicians, health plan case managers, social workers, and community resources.

If you are interested in having your patient work with a Registered Nurse Health Coach, fill out the physician referral form or contact us by calling 1-800-313-8628.

Health Coaches

Health Coaches offer condition management support to all eligible members.

Health Coaches help members work effectively with their physicians to make “shared decisions” that are right for them.

Eligible members can speak with a Health Coach directly 24 hours a day, 7 days a week by calling 1-800-275-2583.

Eligibility

Most AmeriHealth members covered through fully-insured employer groups are automatically considered eligible for condition management. Members covered through certain self-insured employer groups may not be eligible for the programs. Members may call Customer Service at 1-800-275-2583 to verify their eligibility. Condition Management actively reaches out to members with identified clinical needs who may benefit from personal health education and support. Eligible members have access to the program at any time, 24 hours a day, 7 days a week, by calling 1-800-275-2583.

Provider Rights and Responsibilities

Condition Management values the importance of the physician-patient relationship and is designed to enhance evidence-based care. The program is based on open and collaborative communication among the provider, their patients, and Health Management Program staff. We ask all participating providers to review their rights and responsibilities.

Provider Rights and Responsibilities