Why choose ABMG?
Membership in ABMG provides patients with the best possible arrangement of services. Not only do you see physicians who retain control of their own practice and agree to see health plan patients within the quality guidelines established by ABMG, but also you are part of a network of physicians who provide quality services for all your health care needs, including:
- Health maintenance and disease prevention
- Comprehensive, coordinated medical care
- Highest medical standards for our participating physicians
- Personalized, timely, effective services
Alta Bates Medical Group is committed to providing you the highest level of care possible. Our customer service staff will assist you with any inquiries and can help guide you through the often-confusing health care experience.
Quality & Utilization Management
Patient Management is based upon the premise that dedicated staff, through the use of integrated review activities, can contribute to improving the care delivered to members by independent health care providers within a managed care system. This type of integrated managed care system should have the capacity to offer provider contracting. Patient Management, and data analytical services for all significant heath care benefits, including medical surgical care, coordination with behavioral health care, and long-term case management.
ABMG incorporates the above premise through the combined efforts of nurses, medical directors and other staff in the Quality/Utilization Management Department.
The Quality & Utilization Management Plans emphasize coordination, facilitation and education of members and providers. This plan emphasizes early case identification, communication and proactive intervention through certain disease management programs. ABMG promotes consistency throughout its health plans and its various products in process and decision making. This enhances efficient resource utilization and it’s designed to maximize administrative efficiency.
The Quality & Utilization Management Programs strives to provide quality health care with appropriate resource utilization. Under utilization of services is monitored at both the plan and individual provider level to ensure all our members have access to appropriate care.
ABMG requires that physicians and health professionals make medical decisions based on the member's medical needs. Decisions to deny or forego a treatment or services must be made by an appropriately qualified licensed physician. ABMG does not compensate anyone for denying coverage or services and does not use financial incentives direct or indirect, to encourage denial of any medically necessary services.