Case Management – Jason and Kelly
Estimated $209,000 savings to the health plan*
"Jason" and his daughter "Kelly" were spending an evening with family and friends at a backyard cookout when a gust of wind caused burning oil from tiki torches to splash onto Kelly’s face, arms, hands and upper body. Some of the oil also landed on Jason’s torso and thighs. They were both burned immediately. Thirty percent of Kelly’s body was covered in third-degree burns. Kelly and Jason were airlifted to the only hospital that was available and capable of treating them several hours from their home.
- American Health’s case manager immediately began coordinating with Kelly and Jason’s doctors. The case manager’s work on the case included:
- Arranging for Kelly and Jason’s care to be paid at in-network rates. Much of the care they received was out of network, because no qualified network providers were available in their area.
- Arranging therapies and getting dressing supplies provided to the family
- Coordinating withthe Ronald McDonald House, an organization that provides housing for family members of hospitalized children
- Contacting multiple burn organizations including the Children’s Burn Foundation, Shriners Hospital, and J.R. Martinez, burn survivor and winner of Dancing with the Stars
- Researching vacations for burn victims, and Kelly and her family got to go on multiple trips
- Writing to the president of Kelly and Jason’s favorite baseball team to receive memorabilia that was auctioned to raise money for their medical bills
Kelly has returned to school. She is attending an after-school club for burn victims and has bonded with another child who was severely burned. She is taking French horn lessons as part of her therapy and walks to and from school with Jason, who works at the school.
*Case savings include managed savings and negotiated savings and follow guidelines prescribed by the Case Management Society of America (CMSA). Managed savings reflect avoidance of potential charges that are realized through the intervention/actions of the case manager. Negotiated savings reflect savings off actual charges that are negotiated by the case manager with an individual provider.
Disease Management – Evelyn
Estimated $23,000 annualized savings to the health plan*
“Evelyn” is a female in her 50's who enrolled in Disease Management with chronic pain. She had just had an emergency surgery and was at what she called “a very dark time in my life.” She was unemployed, overweight, making unhealthy choices, in pain from her surgery and depressed. Evelyn was in the obese range. During her initial call with her coach, Evelyn was very upset and realized how poor her mental and physical health had become.
Over the course of their coaching relationship, Evelyn’s coach was kind and compassionate. She provided healthy resources, encouraged Evelyn to make changes in her lifestyle, and praised her progress. Evelyn says she “gained confidence, strength and a renewed love of life.” She chose a new diet plan and began exercising daily. The weight began to come off, and her pain decreased.
More than a year after enrolling in Disease Management, Evelyn has lost 65 pounds, is pain free and describes herself as “fit and healthy.” Her BMI has dropped to 20, in the normal range. She regularly runs in races, has a new career and says her marriage is stronger than ever. She praised her nurse health coach, saying, “This is a woman who I have never met face to face (and probably never will), but she made me so comfortable that I feel as though we have known each other forever. She did for me what my friends, family and I were not able to do – help me see that I deserve good health and a good life. She helped me to gain a confidence I have never had.”
*Savings are based on evaluating paid claim trends for participating vs. non-participating members, or alternatively, by applying a research-based dollar value to changes in the participating member's Patient Activation Measure score.
Medical Transportation – Andrew
Estimated $22,000 in savings to the health plan*
American Health’s Medical Transportation team was contacted to facilitate an emergency transfer for “Andrew,” a kid that was struck and pinned under a dump truck. The team completed Andrew’s transportation by emergency air ambulance to a pediatric trauma center. After four weeks of acute inpatient care, Andrew was ready to be transferred home for rehabilitation therapy. He could not be transported by ground ambulance due to inclement weather and a long travel distance. Andrew had a broken left leg that was immobile, but was stable and did not require an expensive air ambulance transfer.
The Medical Transportation staff researched commercial airline carriers and coordinated with the airline’s medical unit to make arrangements. Andrew was transferred to the airport by a wheelchair-accessible van and was able to board the plane early. The Medical Transportation team had arranged for him to have a row of three seats, allowing him to stretch out his injured leg. An attendant was waiting at the destination to transfer Andrew to a waiting ground ambulance.
Andrew’s transport went smoothly, and he is now home. Traveling by commercial airline resulted in significant savings compared to an air ambulance.
*Includes savings for units that were non-certified, managed savings that reflect avoidance of potential charges that are realized through the intervention of the case manager, negotiated savings that reflect savings off actual charges that are negotiated with a provider and bill review savings for identified erroneous charges.
These communication is intended for informational, promotional purposes only. The reference to previous outcomes made as a part of this communication does not guarantee success in any new or future case(s), as the result of each case depends upon many factors, including the facts of each case.
The value that American Health brings to our clients and members is invaluable to our company. In a recent case, American Health coordinated the transfer of a plan member's daughter to a nearby hospital following a tragic accident. Relieving the burden of responsibility to the family while carefully managing costs is the type of service we can expect from American Health.
Simplifi Health Benefit Management, LLC Columbus, OH
Allied has long partnered with American Health for medical management services to complement our strong position within the health care market payer space. We view American Health as an industry leader, innovator and good strategic partner.
Allied Benefit Systems, Inc. Chicago, IL
American Health Holding is always looking at ways to innovate and offers each client the opportunity to customize a program that fits their unique needs. Their specialized medical professionals combine compassion, patience and unique knowledge about health care navigation to support the member and plan from both a quality of care and cost perspective.Holly Weiske
Director of Client Services
Cypress Benefit Administrators Appleton, WI
The expertise that American Health provides to the aeromedical transfers allows us to facilitate and expedite the process. Their compassion and empathy for the patient and the patient's families sets a standard to which all health care providers should strive to achieve.Craig Poliner
MedEscort International, Inc. Allentown, PA
We have been working with American Health since 2011 and find great value with their products and services. Their staff is always supportive and helpful, and they are above average outfit that offers superior service.Sandra L. Dickerson
Decision Science Inc. Baltimore, MD
Swiss Re Corporate Solutions considers AHH to be one of our preferred vendors because they have programs in place to help manage complex diseases such as cancer. If supported by the plan document, AHH can proactively review patients and assist with second opinions to ensure accurate diagnosis, testing and that the most appropriate treatment protocol is being followed. Additionally, AHH case managers help employees select in-network facilities that have the best outcomes for the diagnoses and negotiate costs of care while maintaining a focus on the employee and their dependents. AHH helps employees regain their optimum levels of wellness and simultaneously protect plan assets.Matt Leming
Sales Leader, VP
Swiss Re Overland Park, KS