AAG offers a comprehensive set of health management solutions with a multi-dimensional medical management strategy, addressing all aspects of health care - quality, utilization, delivery and cost. Our array of service options allow employers to focus on the areas of member population where there is the greatest potential for savings and the greatest potential for improved member health and overall satisfaction.
Use of predictive models through the analysis of members’ monthly claims data and prescription data identifies tomorrow's high-risk members. Chronic conditions are the leading drivers of rising health care costs. Studies have indicated that typically 15% of members with chronic diseases drive 50% of claims costs. The Journal of the American Medical Association has calculated the average yearly cost for a person with one chronic condition is $1,829 and jumps to more than $4,600 for persons with more than one chronic condition. Our program encourages members with chronic diseases to actively manage their health, which helps reduce lost work time and hospitalizations while promoting a better quality of life.
Our HRAs include questions covering major risk factors, family and personal medical history along with other valuable information. The combination of this data and any additional clinical values that may be available allows the assessment to clearly identify an individual’s most prevalent health risks, and offers specific feedback for both the individual’s health risk and the population health risk as a whole. HRAs employ health and motivational research to assess individual health status and risk in various delivery options, including online, paper and Spanish versions. Utilizing accepted industry studies and tested results, our assessments have established validity and reliability.
These appraisals address indicators specific to the elderly including major lifestyle factors, functional health status, quality of life, readiness-to-change and self efficiency. Retirees receive a personalized assessment report while clients receive an aggregate report outlining the overall status with recommendations. In addition, our Senior Wellness Center is a tool specifically created to provide retirees with the latest information on a variety of health topics ranging from living with chronic conditions to safety issues around the home.
This program is designed for significant potential savings for the reason that these individuals have the opportunity to avoid the clinical and financial impact of chronic disease through improved lifestyle habits and self-care choices. The Wellness Coach program is a 12-week self-directed health education program that is focused on the achievement of behavior modification goals. The following lifestyle programs have been developed to motivate and support individuals to take charge of their wellness state through education, goal-setting and accountabilities:
- Smoking Cessation
- Blood Pressure Management Program
- Weight Management
- Exercise and Fitness Program
- Stress Management Program
- Cholesterol Management Program
- Self-Care Topics Program
Employer-sponsored clinics allow employees and their dependents to enjoy the benefits of having doctors and nurses on staff to answer questions and assist with common illnesses and procedures. Our physicians and nurses are dedicated to only your employees and dependents. By having a dedicated medical team, you are able to decrease absenteeism and provide additional benefits to your employees and their dependents. Also, employees and their spouses will participate in a wellness assessment program and receive a personalized health report complete with a health improvement plan.
Members have direct contact 24x7 to experienced, caring nurses providing a convenient and highly credible first point of contact for medical questions or concerns. These nurses answer questions, explain medical options and suggest resources. They encourage members to receive timely care in the most appropriate setting and support these suggestions with clinical information.
This program provides early identification of potential risk factors and helps expectant mothers take measures to ensure a healthy delivery and a healthy baby. Nearly one-quarter of all pregnant women face factors that threaten the health of both mother and baby. AAG’s early intervention maternity screening program can anticipate such medical complications and avert them, as well as the often staggering medical costs that can follow. Throughout the program, which is designed as a member advocacy program and resource for expectant families, the patient will have access to a toll-free pregnancy information line staffed by maternity R.N. specialists.
Nurses know that managing for quality will result in the most effective care and - in the long run - control costs. Our nurses address patient needs, diagnosis and prognosis, care environment and available alternatives. AAG has a multi-tiered approach to identify potential cases for case management. As a result, our ability to properly identify case management situations is greatly enhanced.
Our case managers evaluate the best option for quality care and cost effective pricing on an individual basis for each transplant case. All possible network relationships are investigated from PPO providers to the reinsurance network. AAG has also contracted with two national networks to provide individual access if needed. Our case managers also negotiate on an individual basis if necessary, and evaluate statistical data from Transplant Centers when indicated. Centers of Excellence are accessed whenever possible and global case rates are implemented to include pre and post transplant care if possible.
We work closely with clients, advisors and the prescription vendor to make the prescription drug benefit more affordable through plan design, patient-care management and special programs. Programs are designed to meet client specific needs for controlling costs and improving employee satisfaction.
Nurses work with patients and providers to serve the patient's best interests ensuring appropriate care and maximizing clients' medical plans. Nurses evaluate and determine medical necessity and setting appropriateness for each requested procedure. Issues explored include whether a continued stay is necessary to achieve the desired treatment result and whether there are more cost-effective treatment settings without sacrificing quality care. Our goal is to keep patients healthy by making sure they obtain the right care at the right time in the right setting.
Nurses focus on high-cost, high-utilization outpatient procedures. As medical technology for outpatient treatment has evolved and become more sophisticated, the volume of outpatient medical procedures and associated costs have risen correspondingly. Employers have seen their outpatient costs paralleling their inpatient costs. Our outpatient care management service is designed to help our clients control these expenses.
Flexibility is important to employers and their members. We recognize that one preferred provider organization does not meet the needs of all employers. AAG works with more than 90 networks throughout the country and works to the find the network that best fits the client’s needs.
Significant cost savings are achieved by this program. Most health care plans allow members the flexibility to use providers of their choice. Due to this flexibility or to circumstances beyond members’ control, there are times when high dollar claims are out-of-network. So in addition to managing our clients’ in-network dollars, AAG aggressively negotiates reductions in out-of-network expenditures. Since 1995, AAG's in-house medical management nurses have negotiated with non-network hospitals, physicians and ancillary health care providers to help reduce our clients’ and their employees’ health care expenses. These negotiations encompass a reasonable and customary review of the charge levels, as well as a review of the appropriateness of services rendered. The nurses are supported in their negotiations by a variety of cost databases and claims utilization history. To protect our members from being balance billed, our nurses require providers to sign a release form. Savings are substantial with greater employee satisfaction regarding their health care program.
AAG not only processes claims, but manages them as well. Our total cost management approach allows our clients to clearly manage costs through efficient benefit administration and to avoid additional costs through effective managed care services.