Care Management

Don't Just Cover Costs. Create Savings.

For years, health insurance simply covered health expenses for employers: receive a claim, pay a percentage and move on to the next. While this approach has worked in the past, it doesn't create savings or address the underlying issues that cause rising healthcare costs. 

At Achieve Health Alliance, we believe a health plan should do more than just cover the costs--it should help reduce them. In order to do so, we take a different approach to cost containment. Our approach sees claims for what they truly are: people receiving care. And the best way to reduce costs, both now and in the future, is to ensure that the right care is given at the right time.

Advantages for All

Utilization Management

Appropriate care begins with utilization management and review. By analyzing previous claims data, Achieve Health Alliance creates a health plan that addresses the most common health concerns, whether that be a plan focused on primary care coverage or one design to meet the needs of an aging population. Once the plan has been designed, we continue to monitor the types of treatments being given, giving employers the ability to adjust the plan design as needed, while also giving our team opportunities to handle member health episodes case by case

Case Management

Achieve Health Alliance has a team of clinical experts who handle specific member cases in order to determine the best course of care. Case Management examines the many components that make up an episode of care, including quality, safety, appropriateness of setting and cost to the plan. Our staff engages with members through outreach and follow-up, educating them on their treatment options and providing guidance based on the individual needs of the patient. Our Case Management has proven highly effective with complex cases such as: cancer care, traumas, dialysis, multiple chronic conditions, transplants and high-risk pregnancies. Our program is all about making things easier. There are no complicated changes as to how your benefits work or extra red tape, just a plan that is efficient and effective.

Disease Management

Some members within an employer population may have medical conditions that require long-term maintenance in order to stay healthy, such as asthma, COPD or diabetes, Achieve Health Alliance offers Disease Management programs that are designed to reduce the symptoms associated with their specific condition and keep them from developing any complications. Our program supports at-risk members in staying healthy, protecting both the member and the plan from any complications that could incur high-dollar claims in the future.

Wellness Options

Wellness is more than smoking cessation programs of walking challenges. At Achieve Health Alliance, we approach every facet of member care with long-term wellness and health in mind, both for the member and the plan. The specific wellness programs we offer address a multitude of lifestyle habits, but also have the ability to integrate with our comprehensive Utilization, Care and Disease Management programs.

Learn about Achieve Health Alliance's Care Management & Cost Containment Programs

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