Resource Guide - Alignment Health Plan
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PROVIDER
Resource Guide
2020
10 things to
IMPROVE
PAT I E N T
S AT I S FA C T I O N
S E E PAG E 5
Getting to know
ALIGNMENT’S
MEMBER BENEFITS
S E E PAG E 9
Access greater visibility
PAT I E N T 3 6 0
S E E PAG E 2 4
1
I M P O R TA N T
C O N TAC T I N F O R M AT I O N
Need help? We’re here and ready to answer your questions!
ONLINE SUPPORT
WEBSITE https://www.alignmenthealthplan.com
Click on the Providers section to access information, such
as checking member eligibility, for Alignment partners
and their staff.
PHONE SUPPORT
P R O V I D E R R E L AT I O N S 1-844-361-4712
caproviders@ahcusa.com
E L I G I B I L I T Y V E R I F I C AT I O N 1-888-517-2247
8 a.m.-5 p.m., Monday-Friday
Providers may verify member eligibility for covered
services online or over the phone. https://www.alignmenthealthplan.com/
providers
CLAIMS 1-866-646-2247 (Option #5)
8 a.m.-5 p.m., Monday-Friday
Ask questions and get assistance with claims.
U T I L I Z AT I O N M A N A G E M E N T/
H E A LT H C A R E S E R V I C E S 1-866-646-2247 (Option #4)
8 a.m.-5 p.m., Monday-Friday
Contact our Utilization Management team, which works
to ensure that members, their providers, and Alignment
are all aligned on treatment decisions.
1
PHONE SUPPORT
MEMBER SERVICES
English 1-866-634-2247 (TTY:711)
Customer service for Alignment Health Plan 8am – 8pm, 7 days a week from October
1 through March 31 (except Thanksgiving
members in English.
and Christmas), and Monday through
Friday from April 1 through September 30
(excluding holidays).
Spanish 1-877-399-2247 (TTY:711)
Customer service for Alignment Health Plan 8am – 8pm, 7 days a week from October
1 through March 31 (except Thanksgiving
members in Spanish.
and Christmas), and Monday through
Friday from April 1 through September 30
(excluding holidays).
24/7 DOCTOR 1-844-227-6955
Resource for members needing immediate access to an (TTY: 1-800-877-8973)
ACCESS 24/7 doctor. Services include general medical,
dermatology and behavioral health.
24/7 ACCESS ON-DEMAND CONCIERGE 1-833-AHC-ACCESS
A dedicated concierge team, available to help members 1-833-242-2223 (TTY: 711)
navigate their services and benefits including appointment
scheduling, transportation assistance, and more.
MEMBER PHARMACY HELP 1-844-227-7616 (TTY: 711)
24/7 assistance for members with pharmacy questions,
such as prescription drug benefits and copays.
PHARMACY TECHNICAL HELP DESK 1-844-227-7615 (TTY: 711)
24/7 assistance with technical issues with pharmacies and
prescription claim billing questions.
SALES 1-888-979-2247 (TTY: 711)
8 a.m. - 6 p.m., 7 days a week.
For questions and assistance with enrolling with
Alignment Health Plan.
T R A N S P O R TAT I O N 1-866-327-2247 (TTY: 711)
8 a.m.-6 p.m., Monday-Friday.
Transportation assistance to and from medical
appointments, pharmacies, and more.
2
T R A N S F O R M I N G H E A LT H C A R E
D E L I V E RY S TA R T S W I T H A L I G N M E N T
At Alignment Health Plan, we believe the relationship between doctors and the
communities you serve is second to none. That’s why one of our central values is to
support our network providers with some of the most innovative tools in the world
to provide your patients with a new, higher level of care – together as partners.
Alignment is here to partner with you. As a team, we are committed to provide our
network providers with the highest level of service and technology to put the senior
first, improve satisfaction with their care and help lighten your load. To that end, we
have created this quick and easy guide to help you better understand the unique
benefits exclusively available to Alignment Health Plan members as well as the
resources and services available to our provider network.
If you have any questions, please call your Provider Relations Representative at
844-361-4712, Monday to Friday from 9 a.m. to 5 p.m. We are here for you and
happy to answer all of your questions.
DAWN C. MARONEY
President, Consumer
(844) 310-2247
dmaroney@ahcusa.com
1 1 0 0 W. T O W N & C O U N T R Y R O A D , S U I T E 1 6 0 0 , O R A N G E , C A 9 2 8 6 8 | (844) 310-2247
3
TA B L E O F C O N T E N T S
2020 / PROVIDER RESOURCE GUIDE
Improving Patient Satisfaction 05
Navigate Your Benefits Online 08
MEMBER BENEFITS 09
Grocery Benefit 09
Companion Care Benefit 10
Bonus Drug Benefit 11
ACCESS On-Demand Concierge 12
H E A LT H B E N E F I T S 13
24/7 Access to a Doctor: Teladoc 14
Hearing Services: Hearing Care Solutions 14
Fitness: Peerfit 15
Vision: VSP 16
Dental Services: Liberty Dental Plan 16
Transportation 17
Over-The-Counter Allowance 18
Readmission Prevention Meals and Chronic Condition Meals 20
Alignment Member Rewards Program 20
PROVIDER RESOURCES 21
Patient 360 24
Care Anywhere 25
Medicare Stars Program 27
04
1 0 T H I N G S YO U C A N D O TO
I M P R O V E P A T I E N T S AT I S F A C T I O N . . .
Satisfied patients build trusting relationships with their providers and are more likely to follow clinical
advice, leading to better health outcomes. Along the same vein, dissatisfied patients are more likely
to have poorer health outcomes and share their negative experiences with friends and family or with
the world via an online review.
Consider applying these practical tips at your practice to help improve patient experience and quality
of care.
G E T T I N G C A R E Q U I C K LY
Sample CAHPS®
1. Accommodate Urgent Appointments – Set aside a few appointments
in your daily schedule to accommodate urgent visits and use an effective Questions
triage system to make sure that at-risk patients are seen quickly. Listen to In the last 6 months…
the patient’s needs and offer multiple appointment times.
• When you needed
2. Provide Alternate Options – Offer the option of making an earlier care right away,
appointment with a nurse practitioner or physician’s assistant if the patient’s how often did you
doctor is not immediately available. Alignment Health Plan members may get care as soon
also schedule a telehealth visit with Teladoc through the Alignment Health as you needed?
Plan member portal at https://members.alignmenthealthplan.com or by
calling their ACCESS On-Demand Concierge at 1-833-AHC-ACCESS • How often did you
(1-833-242-2223), TTY 711, 24 hours a day, seven days a week. get an appointment
for a check-up or
routine care as
3. Minimize Office Wait Times – If the doctor is running behind schedule,
soon as you
offer a brief explanation for the delay and provide updates. Have staff
needed?
attend to the patient during the wait by measuring vitals, discussing
health status and providing education as appropriate.
• How often did you
see the person
4. Schedule Routine Care Early On – Encourage your patients to make
you came to
their appointments for routine or follow-up care early on – before they
see within 15
leave your office, if possible.
minutes of your
appointment
time?
5
GETTING NEEDED CARE
Sample CAHPS®
5. Help Schedule Specialist Appointments – Suggest more than one
specialist and call the specialist to coordinate the soonest appointment
Questions
date. In the last 6 months…
6. Offer On-Call Access – After making an appointment, suggest to • How often was it easy to get
patients that they can be added to an “on-call” list so they can be appointments with specialists?
contacted should an earlier appointment time become available.
• How often was it easy to get the
7. Consider Adding Expanded Access When Needed – Does your care, tests, or treatment you
practice offer early morning walk-ins, evening appointments or needed through your health
weekend appointments? Offering extended hours or weekend plan?
appointments can help meet a patient’s care needs.
A TALE OF 2 SURVEYS
EVERY YEAR, TWO SURVEYS ARE ISSUED TO MEASURE
PATIENT SATISFACTION AMONG MEDICARE PLAN MEMBERS
THAT CAN AFFECT MEDICARE STAR RATINGS:
1. CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS
AND SYSTEMS (CAHPS®)* SURVEY
• Typically mailed to plan members between March and
June
• Asks patients about their overall health, the quality of care
they received and the experience they have with your
practice
• All plans that undergo accreditation review by the
National Committee for Quality Assurance use CAHPS
2. HEALTH OUTCOMES SURVEY (HOS)
• Typically mailed to a random sample of plan members
between April and June. Each sample receives a follow-up
survey two years later.
• Asks patients about the care they receive from their
health care providers to measure health outcomes and
effectiveness of care
• Required by Medicare for all health plans with Medicare
managed care contracts
*CAHPS is a registered trademark of the Agency for Healthcare Research and Quality, U.S.
Department of Health and Human Services
6
Sample CAHPS®
Questions
In the last 6 months…
• When you visited your personal
doctor for a scheduled appointment,
how often did he or she have
your medical records or other
information about your care?
• When your personal doctor
ordered a blood test, x-ray or
other test for you, how often did
someone from your personal
doctor’s office follow-up to give
you those results?
• When your personal doctor
C A R E C O O R D I N AT I O N ordered a blood test, x-ray or
other test for you, how often
8. Convey Doctor Engagement – Assure your patients that you did you get those results as
have the relevant information about their medical history. Ask soon as you needed them?
whether they have seen any other providers since their last
visit with you and discuss treatment and next steps as needed. • How often did you and your
personal doctor talk about all
9. Communicate Test Results Promptly – If your patient is
the prescription medicines
having a test done, let him or her know when results are
you were taking?
expected and who will be reporting those results to the
patient. Also let your patients know whom to contact in case
• Did you get the help you
they have any questions about their results.
needed from your personal
doctor’s office to manage your
10. Review Your Patient’s Current Medications – While a patient care among these different
is waiting to see the doctor, clinical staff can review and providers and services?
update the patient’s current medication list and prompt the
patient to raise any specific questions or concerns with the • How often did your personal
provider. During the appointment, providers can review the doctor seem informed and
list and address patient concerns, side effects and/or barriers up-to-date about the care
to adherence. Ensure the patient understands the prescribed you received from specialists?
schedule and encourage adherence.
2
7
N AV I G AT E M E M B E R B E N E F I T S O N L I N E
Alignment Health Plan members can find their benefit information online 24 hours a day, seven days a week. It’s
easy! All they need is their member ID and an email address* to activate their account.
TO REGISTER ONLINE
Go to https://www.alignmenthealthplan.com/members to sign up over the web
or
Download the app to an Apple or Android mobile device by searching for “Alignment Health Plan”
ACCESS MEMBER INFO ACTIVATE THE ACCOUNT FIND INFO WITH
ANYWHERE, ANYTIME WITH MEMBER ID A SINGLE TAP
With an online member account, Alignment Health Plan members can:
1. Connect to a doctor 4. Send secure messages to our Concierge team
2. Access their Member ID card 5. Check their ACCESS card balance
3. View plan benefits and recent claims 6. And more!
*By providing an email address, you are giving Alignment permission to contact you regarding your plan by email. An email address can be associated with
only one member account. Register through the plan’s website at www.alignmenthealthplan.com or by downloading the Alignment Health Plan mobile app.
Once registered, members can access both the website portal and mobile app using the same email address and password.
Not available on the Alignment Health Plan mobile app
8
Member Benefits
NEW FOR 2020
To provide your Alignment Health Plan patients a better, more coordinated
patient experience, the following pages of this guide include an overview of the
benefits and services available to Alignment Health Plan members in 2020.
GROCERY
BENEFIT
WHO QUALIFIES FOR ALIGNMENT’S
G R O C E RY B E N E F I T, A N D H OW D O E S I T WO R K ?
To help members with chronic illnesses meet their nutritional needs,
we have introduced a new grocery benefit for select plans in 2020!
AVAILABLE ONLY FOR THE Qualified members can use their black card to buy eligible
FOLLOWING PLANS: groceries at participating retailers, starting Jan. 1, 2020 (tobacco
and alcohol not permitted)
CalPlus (HMO) 009
$20/month Qualifying conditions include CHF (Congestive Heart Failure),
COPD (Chronic Obstructive Pulmonary Disease), Dementia, Diabetes
Heart & Diabetes (HMO SNP) 010 and Stroke. Other chronic conditions may apply.
$20/month
Medical records will be used to establish qualification for the
AllCare Preferred (HMO) 011 benefit; once qualified, the member will qualify for the remainder
$10/month of the plan year – we encourage members to visit their primary
care physician every year to ensure their medical records are kept
Platinum (HMO) 016 up to date.
$10/month
Monthly allowance will load automatically to the member’s black
card on the first of the month, with no rollover
Members with questions can contact their ACCESS On-Demand
Concierge for help 24 hours a day, seven days a week
9COMPANION CARE
BENEFIT
D O YO U R PAT I E N T S N E E D H E L P W I T H L AU N D RY ?
OR LESSONS ON HOW TO USE SOCIAL MEDIA?
In 2020, Alignment has got that covered with a non-medical companion
care benefit available to qualified members in select plans.
AVAILABLE ONLY FOR THE Grandkids on-demand – feelings of loneliness and isolation can be
FOLLOWING PLANS: detrimental to one’s health, so we are connecting college students
to members who need assistance with non-medical services such as
Platinum (HMO) 008 light house chores, technology lessons and general companionship
CalPlus (HMO) 009 Flexible scheduling – whether it’s an hour a week or four per
month, the typical benefit allows eligible members to receive
Heart & Diabetes (HMO SNP) 010 companionship care up to 12 hours per quarter, with no rollover
AllCare Preferred (HMO) 011 This benefit is for members with qualifying chronic conditions
and who have an identified high risk of hospitalization or other
Platinum (HMO) 016 adverse health outcomes and require intensive care coordination.
Members can call to check eligibility through Alignment’s ACCESS
Platinum (HMO) 018 On-Demand Concierge Team
This beneft covers up to 12 hours per quarter, Qualifying conditions include CHF (Congestive Heart Failure),
48 hours per year. The beneft has a maximum COPD (Chronic Obstructive Pulmonary Disease), Dementia, Diabetes,
of 2 hours per visit per day. and Stroke
Medical records will be used to establish qualification for the
benefit; once qualified, the member will qualify for the remainder
of the plan year – we encourage members to visit their primary
care physician every year to ensure their medical records are kept
up to date
10BONUS DRUG
BENEFIT
In 2020, Alignment Health Plan is offering additional coverage of certain prescription drugs that are not
normally covered by a Medicare Prescription Drug Plan. This supplemental drug list, also known as a
“Bonus Drug List,” is included in our drug formulary at the cost-sharing tier indicated below.
S E X UA L DYS F U N C T I O N
sildenafil citrate tab 25 mg (generic Viagra) Tier 2 (6 tablets/30 days)
sildenafil citrate tab 50 mg (generic Viagra) Tier 2 (6 tablets/30 days)
sildenafil citrate tab 100 mg (generic Viagra) Tier 2 (6 tablets/30 days)
COUGH AND COLD
benzonatate cap 100 mg Tier 4
benzonatate cap 150 mg Tier 4
benzonatate cap 200 mg Tier 4
promethazine w/ codeine syrup 6.25-10 mg/5ml Tier 4
promethazine-dm syrup 6.25-15 mg/5ml Tier 4
pseudoephed-bromphen-dm syrup 30-2-10 mg/5ml Tier 4
P R E S C R I P T I O N V I TA M I N S
cyanocobalamin inj 1000 mcg/ml Tier 4
ergocalciferol cap 50000 unit Tier 2
folic acid tab 1 mg Tier 2
WEIGHT LOSS
phentermine hcl cap 15 mg Tier 4
phentermine hcl cap 30 mg Tier 4
phentermine hcl cap 37.5 mg Tier 4
phentermine hcl tab 37.5 mg Tier 4
IMPORTANT INFORMATION ABOUT BONUS DRUGS:
• Extra Help or Low-Income Subsidies (LIS) CANNOT be used to pay for these bonus drugs
• Amounts the member and plan pay for these bonus drugs will NOT count towards year-to-date
“total drug costs” to qualify for catastrophic coverage
• Tier exceptions do NOT apply
• Members pay the Alignment tier cost or contracted pharmacy rate, whichever is LOWER
• Drugs that do not require a prescription and are available over-the-counter are NOT covered
• Rules are subject to change at any time
11ACCESS On-Demand Concierge
24/7 PERSONALIZED CARE
T H E B L A C K C A R D F O R H E A LT H C A R E
Upon enrollment with Alignment Health Plan, members will receive a black ACCESS
On-Demand Concierge card that works as a debit card, accepted at more than 50,000
locations nationwide. With this card, members can connect with a concierge agent
dedicated to serving their health care needs, 24 hours a day, seven days a week.
FRONT
MEMBER NAME
BACK
UNIQUE ACCESS
ACCOUNT NUMBER
ACCESS ON-DEMAND
CONCIERGE PHONE
NUMBER
Note: The card itself is not required to receive care but acts as a reminder for the member.
Q UEST IO N S ? To learn more about Alignment’s 24/7 ACCESS concierge,
please visit https://www.alignmenthealthplan.com/access or call
1-833-AHC-ACCESS, (1-833-242-2223) TTY: 711.
12Health Benefits Alignment Health Plan members enjoy many benefits that encourage healthy living during retirement.
24/7 ACCESS TO A DOCTOR*
TELADOC
Alignment Health Plan members have 24/7 access to a board-certified doctor
through Teladoc any time of day or night. Services available include general
medical, dermatology and behavioral health consultations. If medically necessary,
a prescription will be sent to the pharmacy of their choice.
Members can set up 24/7 access with Teladoc by using their Alignment Health
Plan member ID. To get started, members can register through their Alignment
Health Plan online member account, call 1-844-227-6955 (TTY: 1-800-877-8973)
or visit https://www.teladoc.com/alignment
https://www.teladoc.com/alignment.
HEARING SERVICES*
HEARING CARE SOLUTIONS
Alignment Health Plan contracts with Hearing Care Solutions (HCS) to provide
hearing care and hearing aids through a network of more than 4,000 provider
locations in the United States.
For questions or to schedule an initial audiogram with an HCS provider,
members can contact HCS at 1-866-344-7756, 5 a.m.-5 p.m. PT, Monday-Friday
(excluding holidays) or visit https://www.hearingcaresolutions.com
https://www.hearingcaresolutions.com.
*NOTE: Benefts vary by plan. Please check Evidence of Coverage or call ACCESS On-Demand
Concierge at 1-833-242-2223, TTY 711, for more information about specifc plan benefts.FITNESS*
PEERFIT
Peerfit is Alignment Health Plan’s new fitness vendor, effective January 1, 2020.
Through Peerfit, members have access to a variety of fitness studios. Members
have access to their fitness benefit through the Peerfit Move program. With
this program, members can enroll in a no-cost membership at
a participating fitness center near them.
To get started, members can go to https://peerfit.com or call Peerfit at
1-855-378-6683, 5 a.m. - 8 p.m. PT, Monday-Friday.
*NOTE: Benefts vary by plan. Please check Evidence of Coverage or call ACCESS On-Demand
Concierge at 1-833-242-2223, TTY 711, for more information about specifc plan benefts.
15VISION*
VSP
Alignment plans have built-in vision plans administered by
VSP to provide members with comprehensive coverage that
keeps their eyes healthy.
To find a VSP provider, members can call 1-833-413-9748 or
visit https://www.alignmenthealthplan.com
https://www.alignmenthealthplan.com.
D E N TA L S E R V I C E S *
L I B E R T Y D E N TA L P L A N
Alignment Health Plan provides preventive dental services to its
HMO members.* This comprehensive dental plan has no monthly
premium, no deductibles and low-cost copayments for more than
250 procedures that include checkups, cleanings, gum care and
restorative work.
Members should always check with the dental office before
receiving services to make sure it is a contracted provider.
For more information, Alignment Health Plan (HMO) members
may call 1-833-413-9746, 8 a.m. to 5 p.m., Monday through Friday
(excluding holidays).
*NOTE: Benefts vary by plan. Please check Evidence of Coverage or call ACCESS On-Demand
Concierge at 1-833-242-2223, TTY 711, for more information about specifc plan benefts.
16T R A N S P O R TAT I O N *
For members who have a transportation benefit, transportation must be scheduled at
least 2 business days prior to the scheduled appointment date to ensure availability.
Alignment’s transportation benefit offers routine transportation to
plan-approved locations at no additional cost to the plan member.
Rides to and from a physician or specialist’s office, lab, pharmacy or
dentist within the plan’s service area may be covered, curb to curb
or door to door. Standard-sized wheelchairs can be accommodated,
and members can also bring an escort or caregiver.
To schedule a ride or check the status of a ride, members can call
1-866-327-2247, 8 a.m.- 6 p.m., Monday-Friday (excluding holidays).
*NOTE: Benefts vary by plan. Please check Evidence of Coverage or call ACCESS On-Demand
Concierge at 1-833-242-2223, TTY 711, for more information about specifc plan benefts.
17O V E R -T H E - C O U N T E R
A L L O WA N C E *
Select plans include a monthly over-the-counter (OTC) benefit that
allows members to use their ACCESS card to buy eligible items at
participating retailers. The benefit reloads onto the card every month,
and any amount that is not spent each month is forfeited.
Members can use their ACCESS card to buy eligible OTC items at
participating retailers such as CVS, Dollar General, Family Dollar, Rite Aid,
Walgreens and Walmart. If members have questions about accessing
their OTC benefit, they can contact their ACCESS On-Demand Concierge
team at 1-833-242-2223.
It’s important to note that members of Alignment Health Plan CalPlus
(HMO) cannot use the ACCESS card to buy OTC items at a local retail
pharmacy. CalPlus (PBP 009) plan members must order their OTC items
for home delivery only by calling 1-844-286-2857 (TTY: 711) or mailing in
their completed order form.
*NOTE: Benefts vary by plan. Please check Evidence of Coverage or call ACCESS On-Demand
Concierge at 1-833-242-2223, TTY 711, for more information about specifc plan benefts.
1819
READMISSION PREVENTION MEALS
AND CHRONIC CONDITION MEALS*
Alignment has partnered with Mom’s Meals to provide refrigerated,
home-delivered meals to eligible members with chronic conditions,
or after discharge from the hospital. Menus include gluten-free, renal
and purée.
Select plans include Post-Discharge Meal Delivery and Meals for
Members with Chronic Conditions (based on criteria). To learn more
about the Readmission Prevention Meal plans, contact an ACCESS
On-Demand Concierge representative at 1-833-242-2223.
ALIGNMENT MEMBER
R E WA R D S P R O G R A M *
As part of ACCESS On-Demand Concierge, Alignment Health Plan
members can earn rewards for completing select wellness behaviors and
preventive screenings, such as getting a flu shot, mammogram or diabetic
eye exam. Getting rewarded for healthy activities is easy!
1 2 3
Members Reward dollars Members use reward
complete a are loaded onto dollars at participating
wellness activity the ACCESS card retailers nationwide
Some examples of rewards-eligible health services may include: flu shot,
diabetic eye exam, mammogram.
*NOTE: Benefts vary by plan. Please check Evidence of Coverage or call ACCESS On-Demand
Concierge at 1-833-242-2223, TTY 711, for more information about specifc plan benefts.
20ALIGNMENT Provider Resources
P ROVID E R RE SO URCES AN D EDUCATION
https://www.alignmenthealthplan.com/providers
The online provider resources and training modules provide tools to
assist with claims submission, coding, compliance guidelines
and more. These tools are available via Alignment Health Plan’s
provider portal, where contract providers may also check
member eligibility online.
ACC E SS E XP RE SS
https://providers.ahcusa.com
A provider authorization system, Access Express is currently
available for contracted IPA providers and directly contracted
providers. This tool is used by providers to initiate and request
authorizations, view status of authorized services and view claim status.
RISK ADJ U ST ME NT DOCUMENTATION
AND CO D ING MO DULES
1-844-499-5633
Providers play a key role in risk adjustment activities for Medicare
Advantage plans as each member’s health status is determined by
the conditions identified and supported in the member’s medical
record documentation.
22CO D ING AND D O C UMENTATION GUIDE
caproviders@ahcusa.com
This document provides correct HCC coding for each condition
and level of severity along with any plan/Medicare-required
documentation to prove condition or equipment need. To access the
Coding and Documentation Guide, sign into your provider account
on https://www.alignmenthealthplan.com/providers and click on
Physician Education.
CO MMO NLY MISSE D CON DITION S
caproviders@ahcusa.com
We offer additional assistance for providers and their staff
on assessing commonly missed conditions and how to
code them correctly. For more information, please email us.
HE ALT H ASSE SSMENT
1-833-AHC-ACCESS / 1-833-242-2223
Health Assessment is a comprehensive whole-person medical and
psychosocial assessment provided to eligible Alignment Health
Plan members. Alignment’s clinical team shares all medical records
and test results from the Health Assessment with the Primary Care
Provider within 72 hours. This provides members with an up-to-date
and comprehensive snapshot of the member’s individual health
status to make a member’s visits more time-efficient.
23PAT I E N T 3 6 0
Patient360 is a provider-facing dashboard that provides a snapshot of
a member’s health and treatment history to help providers facilitate
care coordination. Patient360 is a longitudinal patient record that
allows care providers to access the health plan’s view of information
associated with a member including gaps in care, claims, eligibility,
utilization, pharmacy, labs, care management, communications
and documents.
Patient360 keeps providers engaged with their patients’ care.
It also assesses additional care that may be needed based on
current conditions or issues. Patient360 can be directly accessed
through Access Express.
24CARE ANYWHERE
1-657-218-7500 or e-mail us at
careanywherecoordination@ahcusa.com
for a Care Anywhere referral form.
Alignment’s Care Anywhere is a targeted high-risk program focused on the
delivery of in-home care. Our clinical team, in coordination with a member’s
primary care physician, provides a differentiated care experience, ensuring
the right care is delivered to the right senior at the right time and in the right
place. The Care Anywhere clinical advantage includes:
Utilizing real-time data from 24/7 Doctor - telephonic access to
Alignment’s AI-driven “command Alignment Health Plan physicians
center,” AVA, to create real-time for all Care Anywhere members.
clinical alerts and risk stratification.
Integrated clinical teams providing Transition from hospital to home
in-home care driven by Alignment’s coordinated care, integrated with
proprietary data and analytics. the Alignment Health Plan in-home
clinical team.
The goal of Care Anywhere is not only to reduce unnecessary ER visits and
inpatient care, but also to improve health outcomes and restore humanity in
advanced care planning.
2504 / WHY?
M E D I C A R E S TA R S
PROGRAM
For additional information on Alignment’s Stars Program,
e-mail us at stars@ahcusa.com
At Alignment Health Plan, we strive to meet all CMS star rating criteria and
provide a five-star experience for every member. Alignment’s star rating
directly impacts quality bonuses, which are used to improve benefits and
services for members.
27As a care provider, you play a critical role in achieving this goal and
delivering a superior level of care. Individual provider interactions with
members can impact overall star ratings in the following ways:
Encourage members to complete recommended screenings,
tests, or vaccinations such as a mammogram, colorectal
cancer screening, diabetic eye exam and diabetic lab tests,
bone mineral density (BMD) scan, and the flu shot.
Coordinate care after hospital admissions by reconciling
hospital medications with current medications to reduce
readmissions.
Ensure members have access to timely appointments with
your office and/or any referring specialists and reduce
in-office wait times.
Discuss physical and mental health at all visits and work with
the member on a plan for staying physically active.
Ensure members have access to and understand all aspects
of their care by providing a post-visit sheet or offering the
member access to their medical record.
The actions providers and their staff take can improve the member
experience in these and other ways. For more information on the
CMS star program, and to receive your provider star handbook,
please e-mail stars@ahcusa.com
stars@ahcusa.com.
SECTION 03NEED HELP?
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844-310-2247
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