Amerihealth: Private Insurance Option For Your Healthcare Needs

AmeriHealth is a private health insurance company that provides coverage to individuals, families, and employers. It was established in 1995 as Delaware Valley HMO and initially offered health coverage to employers and staff in specific counties of New Jersey and Pennsylvania. Over the years, AmeriHealth expanded its coverage area and now serves New Jersey, Delaware, and Pennsylvania. The company offers a range of health plans, including Medicare Advantage, Medicaid managed care, and individual and family health plans. With a focus on community and wellness, AmeriHealth provides various programs and resources to support the well-being of its members and promote healthy lifestyles.

AmeriHealth's history and origins

AmeriHealth, initially known as Delaware Valley HMO, was established in 1995 to provide health coverage to employers and their staff in specific counties of New Jersey and Pennsylvania. The company's origins can be traced back to the early 1980s when staff at Misericordia Hospital in West Philadelphia noticed that many Medicaid patients were using the emergency room for primary care, an expensive and inefficient practice. To address this, they created Mercy Health Plan, a voluntary Medical Assistance managed care plan. This later became AmeriHealth Mercy Health Plan in 1996 through a partnership with AmeriHealth First.

Mercy Health Plan's goal was to improve access to care and lower costs by connecting each Medicaid member with a primary care physician, encouraging consistent and proactive healthcare. Over time, this approach proved successful, with more Medicaid recipients adopting regular primary care visits rather than relying on emergency rooms for severe conditions.

In its initial years, AmeriHealth focused on providing health coverage to Pennsylvania employers and their staff in Burlington, Camden, Gloucester, and Salem counties of New Jersey. However, the company quickly expanded its coverage area to include all of southern New Jersey and Delaware. By 1997, just two years after its inception, AmeriHealth offered coverage to the entire state of New Jersey.

Today, AmeriHealth has evolved into a leading healthcare provider, serving more than 265,000 people across New Jersey, Delaware, and Pennsylvania. The company continues to be recognised for the quality of its plans, offering nationwide coverage through Preferred Provider Organisations (PPOs) and third-party administration services. Additionally, AmeriHealth provides employer on-site health coaching and incentive-based wellness programs to promote healthy lifestyles among individuals and groups.

AmeriHealth's services and coverage

AmeriHealth is a private health insurance company that provides coverage to individuals, families, and employers. It offers a wide range of health plans, including Medicare Advantage plans, Medicaid managed care, and individual and family health plans. Additionally, AmeriHealth is committed to addressing health inequities and promoting health and wellness among its members.

Services and Coverage

AmeriHealth offers a variety of services and coverage options to meet the diverse needs of its customers. Here is an overview of their key services and coverage areas:

• Medicare Advantage Plans: AmeriHealth offers Medicare Advantage plans, which provide additional benefits and services beyond original Medicare. These plans are designed for older residents in communities, ensuring they receive the best possible care.
• Medicaid Managed Care: AmeriHealth Caritas, a division of AmeriHealth, specializes in providing Medicaid managed care health plans. They serve Americans nationwide, including low-income and chronically ill populations, by offering innovative, cost-effective care solutions.
• Individual and Family Health Plans: AmeriHealth understands the importance of catering to the unique needs of individuals and families. They offer a range of quality health plans, both on and off the Exchange, providing flexibility and choice to meet individual requirements.
• Behavioral Health Care: Through PerformCare®, AmeriHealth provides innovative, confidential, and customizable behavioral health plans. They also offer substance abuse support services, recognizing the importance of mental health in a person's overall well-being.
• Long-Term Services and Supports (LTSS): AmeriHealth offers LTSS solutions for vulnerable citizens, including the elderly and people with disabilities. They provide compassionate care and assistance with everyday tasks, such as bathing, dressing, and medication management.
• Pharmacy Benefits Management: AmeriHealth delivers innovative and cost-effective pharmacy benefit services for Medicaid, Medicare, and commercial health plans. They offer customized solutions to exceed customer needs and improve health outcomes.
• Health and Wellness Programs: AmeriHealth is committed to enhancing the health and well-being of its members. They offer various programs, such as Commit2Wellness Rewards, which incentivizes and supports healthy lifestyle choices, and health coaching services with nurse wellness specialists.
• Network Coverage: AmeriHealth has a strong presence in New Jersey, Delaware, and Pennsylvania. They have the largest hospital network in New Jersey and a broad physician network throughout these states, ensuring convenient access to quality care for their members.

AmeriHealth's awards and recognition

AmeriHealth Caritas, a private health insurance provider, has been recognised and awarded for its achievements in healthcare. With a presence in 13 states and the District of Columbia, AmeriHealth Caritas has been consistently honoured for its excellence in health plans, wellness programmes, and executive leadership.

The company has received numerous awards and accreditations, including recognition from the National Committee for Quality Assurance (NCQA) for its Multicultural Health Care Distinction, Long-Term Services and Supports Distinction, Managed Behavioral Healthcare Organization, and Utilization Management, among others.

AmeriHealth Caritas has also been accredited by the Utilization Review Accreditation Commission (URAC) in various areas, including Pharmacy Benefit Management, Drug Therapy Management, and Specialty Pharmacy. Additionally, they have been designated as a Rare Disease Pharmacy Center of Excellence and received accreditation from the Accreditation Commission for Health Care (ACHC) for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies.

Beyond these achievements, AmeriHealth has also been recognised for its community involvement and commitment to addressing health inequities. AmeriHealth New Jersey, for instance, is a sponsor and participant in the Special Olympics New Jersey's annual "Lincoln Tunnel Challenge," drawing a crowd of 3,500 runners and walkers in 2009. Furthermore, AmeriHealth received the New Jersey State Governor's Volunteerism Award, demonstrating its dedication to serving and improving the communities in which it operates.

AmeriHealth's partners and community involvement

AmeriHealth has a strong commitment to community involvement and has established several partnerships to achieve this. The company has received the New Jersey State Governor's Volunteerism Award, demonstrating its dedication to serving the communities in which its members live.

One notable initiative is the Care Crew, an employee volunteer programme that actively promotes and partners with small, women-owned, and minority-owned businesses. AmeriHealth has increased its procurement from these diverse businesses by 87% since 2013, showcasing its support for multicultural communities.

In addition to promoting supplier diversity, AmeriHealth is dedicated to addressing health inequities and supporting underserved populations. For over 40 years, AmeriHealth Caritas has helped Americans access care, maintain their well-being, and build healthy communities. They provide integrated healthcare solutions, including Medicaid and behavioural health services, with a focus on person-centred, whole-person care models.

AmeriHealth is also committed to improving mental health and well-being. Through PerformCare®, their full-service behavioural managed healthcare company, they offer confidential and customizable behavioural health plans and substance abuse support. Recognising the importance of mental health, AmeriHealth also emphasises the mood-boosting power of journaling as a tool to improve mental well-being.

Furthermore, AmeriHealth has partnered with various organisations to promote community health and well-being. They are the name sponsor of the New Jersey Devils' practice facility, the AmeriHealth Pavilion, contributing to the revitalisation of Newark. They also participate in events such as the Special Olympics New Jersey's annual "Lincoln Tunnel Challenge" and sponsor local teams and educational institutions, including Rutgers University and the Larc School for disabled students.

AmeriHealth's response to the Change Healthcare HIPAA breach

AmeriHealth is a private health insurance provider that offers affordable health plans for individuals, families, and employers. In 2024, AmeriHealth was one of the many companies affected by the Change Healthcare cyberattack and data breach. Change Healthcare is a healthcare clearinghouse and a business associate of AmeriHealth. The cyberattack on Change Healthcare resulted in a data breach that potentially exposed the personal and health information of millions of individuals throughout the United States.

In response to the Change Healthcare HIPAA breach, AmeriHealth expressed its commitment to helping its members navigate the process. The company stated that it would assist its members in understanding the impact of the breach on their private medical records and healthcare. AmeriHealth also assured its members that they would receive the necessary notifications and information regarding the breach.

As a covered entity, AmeriHealth had certain responsibilities and obligations under the Health Insurance Portability and Accountability Act (HIPAA) to ensure the protection of its members' private information. The company was required to conduct a thorough investigation into the breach, notify the affected individuals, and take appropriate steps to prevent similar incidents from occurring in the future.

To comply with HIPAA requirements, AmeriHealth coordinated with Change Healthcare and other relevant entities to ensure that breach notifications were sent out to the affected individuals. The company also offered support and guidance to its members, helping them understand their rights and options in the aftermath of the breach. Additionally, AmeriHealth worked closely with cybersecurity experts and law enforcement to enhance its security measures and protect its members' data.

The response of AmeriHealth to the Change Healthcare HIPAA breach demonstrated its commitment to safeguarding its members' private information and providing support during a challenging time. The company took proactive steps to address the breach, mitigate its impact, and prevent future incidents. This response reflected AmeriHealth's dedication to maintaining the trust and confidence of its members.

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