tennessee-populationhealth | Providers – Amerigroup

Our Population Health program in Tennessee is part of our comprehensive Health Care Management Services program.

Member Eligibility

All Amerigroup Community Care members with diagnoses of the conditions below are eligible. Members are identified through continuous case finding, welcome calls and provider referrals. Please refer patients who can benefit from additional education and care management support.

  • Asthma
  • Diabetes
  • Schizophrenia
  • Bipolar Disorder
  • HIV/AIDS
  • Smoking Cessation
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Hypertension
  • Substance Use Disorder
  • Conjestive Heart Failure (CHF)
  • Major depressive disorder — adult and child/adolescent
  • Weight Management
  • Coronary Artery Disease (CAD)
  • Obesity

  • Population Health Programs

    TThese programs are based on a system of coordinated care management interventions and communications designed to help you and other health care professionals manage members with chronic conditions. Services include a holistic, member-centric care management approach that allows case managers to focus on multiple needs of members. Motivational interviewing techniques are used in conjunction with member self-empowerment.

    Wellness

    Members can access quarterly newsletters online to learn about their health plan benefits, special programs they may qualify for, health tips, medical news and more.

    Health-Risk Management

    Eligible members receive:

    • Education materials emphasizing self-management strategies for healthy behaviors like accessing health care services, maintaining collaborative relationships with providers, maintaining a healthy weight, being tobacco-free and self-monitoring.
    • Introductory packages upon enrollment in the program that provide information about availability of nurse coaching.

    Chronic Care Management

    This program:

    • Offers a continuum of targeted intervention — education and enhanced access to services intended to encourage member self-management.
    • Supports members through screenings, assessments and tailored interventions.
    • Sends eligible members condition-specific education materials addressing:
      • Information about their primary diagnoses.
      • Self-management strategies.
      • Medication adherence.
      • Coordination of services.

    By using these tools and working with a case manager, the member’s behavioral, social and physical health care needs are addressed.

    Low- and High-Risk Maternity

    Once identified from enrollment as pregnant, members are stratified as low-, medium-, high- or urgent-risk OB based on responses to screeners and are provided varying levels of support based on clinical risk factors.

    All identified pregnant members, regardless of stratification level, receive Taking Care of Baby and Me© program packets, including education materials and gift incentives to encourage mothers to make and keep prenatal and postpartum appointments. All pregnant members have access to educational materials and Amerigroup on Call, our 24/7 Nurse HelpLine. We track and report Taking Care of Baby and Me packets as well as the number of gift incentives used by members.

    Care Coordination

    Complex Case Management

    We administer an initial health risk assessment to members identified for the Complex Case Management program. The case manager assesses the member’s total health care needs in a holistic manner, including physical, behavioral, functional, cognitive and social factors — this includes a gap analysis to determine health care needs and prioritize goals. Once needs are identified, the case manager works with the member and health care provider(s), family and caregiver(s) to develop interventions to achieve identified goals.

    Examples of interventions include:

    • Health education.
    • Interpretation of benefits.
    • Community resource referrals.
    • Post-discharge service authorizations and member outreach (e.g., DME, home health services and coordination of physician appointments).
    • Service coordination.
    • Medication reconciliation review.
    • Assistance to develop a self-management plan.
    • Community-based services (e.g., home or hospital visits).
    • Provider-based intensive case management (behavioral health).
    • Special needs program interventions.
    • Ongoing assessment of barriers to meeting goals or complying with the care plan and interventions to address those barriers.

    How the program works

    Our case managers obtain your input in the development of care plans. Members identified for participation are assessed and risk stratified based on the severity of their diseases. Once enrolled in a program, they are provided with continuous education on self-management concepts like primary prevention, behavior modification and compliance/monitoring, as well as case/care management for high-risk members.

    Providers can access Patient360 to obtain feedback on their members regarding their care plans and condition management while enrolled in Disease Management Features:

    • Proactive population identification
    • Evidence-based national practice guidelines
    • Collaborative practice models include physician and support-service providers in treatment planning for members
    • Continuous patient self-management education, (including primary prevention, coaching healthy behaviors and compliance/monitoring) case/care management for high-risk members
    • Ongoing communication with primary and ancillary providers regarding patient status
    • NCQA accreditation for nine of our programs, which incorporate outreach, education, care coordination and follow-up to improve treatment compliance and enhance self-care.

    Population Health objectives include:

    • Addressing gaps in care.
    • Improving the understanding of disease processes.
    • Improving the quality of life for our members.
    • Providing opportunities for patient-centered care.
    • Supporting network provider relationships with members.
    • Increasing network provider awareness of DM programs.
    • Reducing acute episodes requiring emergent or inpatient care.
    • Identifying barriers to health care and addressing them by referring members to appropriate community resources.

    All of our programs are based on nationally approved clinical practice guidelines available in the Provider Resources & Documents library of this site. You can print online or call our Provider Services team at 1-800-454-3730 to request a copy.

    Case management hours of operation

    Our case managers are licensed nurses or social workers available from 8:00 a.m. to 5:00 p.m. Central time Monday through Friday. Confidential voicemail is available 24 hours a day. Amerigroup On Call is available for our members 24 hours a day, 7 days a week.

    Contact Information

    Please call 1-800-454-3730 to reach an Amerigroup case manager. Members can get information about Population Health at www.myamerigroup.com or by calling 1-800-600-4441 (TTY 1-800-855-2880 ).

    pdf icon Population Health Referral Form

    Population Health rights and responsibilities

    Provider rights and responsibilities

    You have additional rights and responsibilities, such as the right to:

    • Obtain information about the organization’s services, staff qualifications and any contractual relations.
    • Decline to participate in or work with the organization’s programs and services on behalf of their patients.
    • Be informed how the organization coordinates interventions with care plans for individual members.
    • Know how to contact the case manager responsible for managing and communicating with their patients.
    • Be supported by the organization when interacting with members to make decisions about their healthcare.
    • Receive courteous and respectful treatment from the organization’s staff.

    These rights and responsibilities are available to you in written format upon request to DM by calling 1-888-830-4300.

    Clinical Practice Guidelines are available to our providers on our secure provider website (login is required). They also can be faxed to providers at any time upon request.