United Healthcare 2009 Annual Report Download - page 7

Ovations also provides complete, individualized care planning and care benefits for aging, disabled and
chronically ill individuals. Ovations serves approximately 365,000 individuals (including approximately 255,000
individuals in the Medicare Advantage products) across the nation in long-term care settings including nursing
homes, community-based settings and private homes, as well as through hospice and palliative care. Ovations
offers services through innovative care management and clinical programs, integrating federal, state and personal
funding through a continuum of products from Special Needs Plans and long-term care Medicaid programs to
hospice care, and serves people in 35 states and in the District of Columbia in home, community and nursing
home settings. These services are provided primarily through nurse practitioners, nurses and care managers.
Ovations also offers a comprehensive eldercare service program providing service coordination, consultation,
claim management and information resources nationwide. Proprietary, automated medical record software
enables the Ovations clinical care teams to capture and track patient data and clinical encounters, creating a
comprehensive set of coherent care information that bridges across home, hospital and nursing home care
settings for high-risk populations. Ovations also operates hospice and palliative care programs in 16 local
markets in 11 states.
AmeriChoice
AmeriChoice provides network-based health and well-being services to beneficiaries of State Medicaid
Children’s Health Insurance Programs (SCHIP), and other government-sponsored health care programs.
AmeriChoice provides health insurance coverage to eligible Medicaid beneficiaries in exchange for a fixed
monthly premium per member from the applicable state. AmeriChoice also offers government agencies a number
of diverse management service programs, including a clinical care consulting program, disease and conditions
management, pharmacy benefit services and administrative and technology services, to help them effectively
administer their distinct health care delivery systems and benefits for individuals in their programs. AmeriChoice
also contracts with CMS for the provision of Special Needs Plans serving individuals dual-eligible for Medicaid
and Medicare services. These programs are primarily organized toward enrolling individuals who are dual-
eligible for Medicaid and Medicare coverage in states where AmeriChoice operates its Medicaid health plans. As
of December 31, 2009, AmeriChoice covered 2.8 million beneficiaries through all of its programs in 22 states
and District of Columbia.
AmeriChoice’s approach is grounded in its belief that health care cannot be provided effectively without
considering all of the factors (social, behavioral, economic, environmental, and physical) that affect a person’s
life. AmeriChoice coordinates resources among family members, physicians, other health care professionals and
government and community-based agencies and organizations to provide continuous and effective care. For
members, this means that the AmeriChoice Personal Care Model offers them a holistic approach to health care,
emphasizing practical programs to improve their living circumstances as well as quality medical care and
treatment in accessible, culturally sensitive, community-oriented settings. For example, AmeriChoice’s disease
management and outreach programs focus on high-prevalence and debilitating illnesses such as hypertension and
cardiovascular disease, asthma, sickle cell disease, diabetes, Human Immunodeficiency Virus/Acquired Immune
Deficiency Syndrome (HIV/AIDS), cancer and high-risk pregnancy. AmeriChoice has developed several of these
programs with the help of leading researchers and clinicians at academic medical centers and medical schools.
For physicians, the AmeriChoice Personal Care Model means assistance with coordination of their patients’ care.
AmeriChoice utilizes sophisticated technology to monitor preventive care interventions and evidence-based
treatment protocols to support care management. AmeriChoice operates advanced and unique pharmacy
administrative services, including benefit design, generic drug incentive programs, drug utilization review and
preferred drug list development to help optimize the use of appropriate quality pharmaceuticals and concurrently
manage pharmacy expenditures to levels appropriate to the specific clinical situations.
For state customers, the AmeriChoice Personal Care Model means increased access to care and improved quality
for their beneficiaries, in a measurable system that reduces their administrative burden and lowers their costs.
AmeriChoice considers a variety of factors when determining in which state programs to participate and on what
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