Acute Illness Management

Health problems present at various times and vary in severity and complexity. Many are minor illnesses that require short-term care. Others are categorized as chronic conditions that require life long, ongoing coaching support and medical care to mitigate the impact to one’s health and lifestyle such as a cancer diagnosis. And there are those illnesses that are acute, which are typically associated with rapid onset. Acute illnesses can be minor, such as a cold or the flu. Others are more severe and stem from, for example, automobile or other traumatic accidents, or illness precipitated by another diagnosis.

The Acute Illness Management program is designed to identify and provide coaching support to those individuals experiencing the more severe acute illnesses, defined as having a Predicted Allowed amount of $25,000 or greater. When identified, Registered Nurse Navigators and Case Managers perform scheduled outreach to provide coaching assistance and direction on how to manage their illness most effectively.

The goal of A.I.M. is two-fold: Assist the members in managing their complex health issues while controlling claims costs through early identification and intervention.