Integrated Health Care Management
AmeriHealth Caritas Iowa members can join our integrated health care management (IHCM) and medical management programs. We appreciate your assistance in letting our members know about these programs and informing us if any of your patient members could benefit from these programs.
Rapid Response and Outreach Team
Our Rapid Response and Outreach Team addresses the members' needs and supports providers and their staff. The team is composed of non-clinical care connectors. The team:
- Receives inbound calls.
- Conducts outbound outreach activities.
- Provides care coordination support.
Members and providers may request Rapid Response and Outreach Team support by calling 1-855-332-2440, prompt #3.
Pediatric preventive health care – Care for Kids
Care for Kids is designed to improve the health of members younger than 21 years by increasing adherence to Early Periodic Screening, Diagnosis and Treatment (EPSDT) guidelines. We identify and coordinate preventive services for these members, especially when a member is due or overdue for an EPSDT service.
Bright Start® (maternity management)
Bright Start is designed to assist expectant mothers by promoting healthy behaviors and controlling risk factors during pregnancy. The program is based on the prenatal care guidelines from the American College of Obstetricians and Gynecologists (ACOG). As we identify pregnant members, our staff works to ensure that each is aware of the services and support offered through the Bright Start program.
Episodic care management (ECM)
Our ECM program coordinates services for members with short-term and/or intermittent needs. Members in this program typically have singular issues and/or comorbidities. Care managers with registered nurse (RN) or Master of Social Work (MSW) designations support members by:
- Resolving care access and coordination issues.
- Performing comprehensive member assessments.
- Addressing short- and long-term member goals.
- Developing a member-centered plan of care in collaboration with the member, member caregivers, and the member's physicians.
Complex care management (CCM)
Our nurses work one-on-one with members who have complex medical issues. This includes members with multiple comorbidities and members with a single, complex diagnosis like metastatic cancer.
Community care management team
Our community care management team targets members who have a history of or a risk for a disproportionate utilization of services and cost.
Members in this program receive:
- One-on-one, in-person care from team members.
- Help scheduling needed medical, behavioral health, and social services.
- A member-centered plan of care involving the member, member's caregivers, community-based services, and physicians.