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During Hurricane Sandy, Alicare Medical Management, though located in the path of the hurricane, continued to operate on a 24x7 basis to support its clients. Our dedicated team worked diligently to help our clients cover their phone calls and operations.


In addition to our back up generator, which kicked in when the power went out in our area, we have an off-site disaster recovery location which fortunately was not necessary in this storm.


Our hearts go out to all the people affected by Hurricane Sandy, many of whom are our clients and their members, along with staff in our New York office. On their behalf, the staff at AMM have made generous personal contributions to the Red Cross and AMM will make its annual charitable holiday donation to the Red Cross to support the Hurricane Sandy relief efforts.

 

Issue 2, 2012

President’s Message: Control Readmissions with Patient Transition Coaching

Claire Levitt Claire Levitt, MS, President,
Alicare Medical Management


Decreasing readmission rates and easing patient transitions are primary concerns in today’s health care industry, and case managers are in the position to make a huge impact on the education and support of patients. Find out more about what can be done from the case management perspective and what you can do to assist your patients as they move through the care continuum.

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Engaging Consumers in Health and Wellness

Julie O’Brien Julie O’Brien, BSN, RN, MS, Vice President/COO,
Alicare Medical Management


Chronic diseases are the most costly of all health problems, but most are preventable. Maintaining a preventative mentality toward health care will not only improve the health of the American public, but will boost the wellbeing of our economy.

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Client Spotlight: BCBS of Rhode Island

Blue Cross Blue Shield of Rhode Island has partnered with AMM to manage utilization in skilled nursing facilities for members of the Medicare Advantage Program. Find out more about this quality initiative and what AMM and BCBSRI are doing to meet patient needs and facilitate reduced stays in Rhode Island’s skilled nursing facilities.

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Clinical Update: Pertussis on the Rise

Mirroring our country’s financial woes, whooping cough—a memory from the great depression—has reemerged as a disease of serious concern. Although the vaccine rate for children nationwide is high, the effectiveness of the vaccine decreases over time. Continue reading to find out more about the symptoms, diagnosis, and treatment of this contagious disease.

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Employee Spotlight: Barb Shaffer

Barb Shaffer Barb Shaffer, AMM’s director of case management knew it was her calling to work in the health care industry and has dedicated her career to helping others. Find out more about Barb and her role at Alicare Medical Management.

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Provider Profile: Dr. Polachek - A Vital Part of the AMM Team

Sheila BerriganEach day Alicare Medical Management taps into a diverse and dynamic panel of physician experts to support our care management programs. One of these experts is Dr. Beth Polachek, a physical medicine and rehabilitation physician who is also an integral part of the AMM review team.

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AMM’s DRG Validation Services

Alicare Medical Management’s DRG Validation program ensures that each hospital bill priced using a DRG methodology has been assigned the correct DRG code. The DRG codes correspond directly to the hospital’s reimbursement and the payment can be significantly affected by the coding that is assigned. A review of the patient’s medical records will validate whether the appropriate procedures and diagnosis codes were used to establish the assigned DRG. Our clinical staff will review for appropriate of the DRG assignment, looking for re-sequencing of the diagnosis and procedures that impact the pricing, and confirmation that the diagnoses and procedures are supported in the records.

We help each client establish parameters for selecting appropriate cases for DRG Validation. These parameters may include dollar thresholds, specific targeted facilities and targeted DRG codes.

We charge on a percentage of savings basis, so clients only incur fees when there are savings generated by the review.

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Medical Management News

  • West Nile Threat Continues
  • Best Diet: Low Carb and low Fat

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