Chronic Care Management. WPS Chronic Care Management Next Generation Disease Management

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Chronic Care Management. WPS Chronic Care Management Next Generation Disease Management"

Transcription

1 Chronic Care Management WPS Chronic Care Management Next Generation Disease Management

2 Taking on Chronic Illness and Winning. People with chronic illnesses make up only 20 percent of your employee population, but they account for as much as 80 percent of total health care costs: 76 percent of hospital admissions, 72 percent of physician visits, 88 percent of prescriptions filled.* In addition, productivity losses related to chronic illnesses often total four times more than the cost of treatment.** Clearly, it pays to tackle chronic illness head-on to improve employee health and rein in spiraling health care costs. That s where WPS Chronic Care Management can help change the game. WPS Chronic Care Management reaches out to members at the first sign of a chronic illness. Our program focuses on providing health education and member support designed to improve adherence to clinical practice guidelines, lower the incidence of hospitalization, and increase the adoption of healthy behaviors. This strategy helps ensure more appropriate, cost-effective care, resulting in reduced health plan costs over time. Breakthrough Strategy Drives Early Identification, Lower Costs. Our comprehensive, integrated chronic care management program advances traditional disease management practice by leveraging the unique advantages of real-time patient-specific pharmacy data and frequent member touch points to enhance identification and engagement. This approach takes advantage of more complete and timely information, with streamlined collaboration between nurses and pharmacists to swiftly identify and address the needs of members at risk, achieving better outcomes and faster, more significant savings. WPS partners with Medco and Healthways, to bring you Optimal Health, this innovative, first-of-its kind, chronic care management program. Optimal Health is a collaborative effort uniting the leading capabilities of Medco Health Solutions, Inc. the world s most advanced pharmacy, and Healthways, the industry leader in total Health and Care Support SM solutions. * World Economic Forum, **National Governors Association Center for Best Practices, 02/2003.

3 Improving Management of Chronic Conditions, One Member at a Time. WPS Chronic Care Management is the next-generation in disease management. We combine the most important elements of traditional disease management, including health education, prevention, and personalized coaching, with the most innovative techniques for identifying and engaging members at risk. Our program is also designed to optimize transparency in reporting, with clearly-defined ways to measure outcomes and return on investment. Faster Identification, When it Matters Most. The first 30 days after diagnosis are critical. This is when members are most open to taking action to improve their health. We take advantage of access to real-time pharmacy data to reach out to members as early as 72 hours of their filling a prescription up to 90 days sooner than most traditional disease management programs. Integrating pharmacy data with medical claims, health risk appraisals, physician-reported data, and a variety of other sources, we employ sophisticated predictive modeling to stratify members into one of four risk levels, from stable to high risk. Based on the member s risk level and other factors, a tailored care plan is created to empower the member to set and achieve health goals that support their physician s care plan. We share this plan with the member s physician so that, together, we can collaborate to identify opportunities to enhance care. Maximizing Care Opportunities through Early Engagement. Real-time pharmacy data allows us to identify and engage members up to three times faster than a traditional disease management program, permitting more effective interactions that lead to sustained behavior change.

4 Tailored Outreach at the Point of Need. Within days of being identified for intervention, members receive a phone call from a registered nurse and a welcome mailing including condition-specific educational materials. After that, we tailor the frequency and intensity of outreach depending on each member s level of risk and the severity of his or her condition. These outreach services include: Personalized educational mailings, self care goals, and coaching. Scheduled care calls. 24/7 access to a dedicated care team. Depression screenings. Good health reminder calls and mailings. Counseling from a specialist pharmacist. Hospital discharge calls. Quarterly newsletter. Free in-home monitoring (for heart failure patients). Members not interested in participating in chronic care management counseling may choose to just receive program mailings, or may choose to opt-out of our program at any time. Targeting the Most Costly Chronic Conditions. The WPS Chronic Care Management team works with members physicians and pharmacists to create and take advantage of teachable moments that promote the adoption of healthier behaviors. We specialize in working with members with conditions and treatment needs, such as: Chronic kidney disease Chronic back pain Chronic obstructive pulmonary disease (COPD) Coronary heart disease Diabetes Heart Failure High-risk asthma We also actively engage physicians to enhance patientdoctor communication, helping to drive greater health improvement and savings. Physicians receive regular calls, faxes, and mailed alerts on member-specific safety risks, including Care Link reports providing evidence-based recommendations to help them identify opportunities for care. We also provide access to a hotline physicians can call to consult with our clinical team or with Medco specialist pharmacists. Precise Measurement that Demonstrates Value. We continuously track and provide program performance reporting so you can evaluate levels of employee engagement and overall results. Our standard reporting includes: Monthly Early Activity and Engagement Report (first 90 days). Quarterly Engagement Report. Semi-Annual Clinical and Utilization Outcomes Report Our transparent reporting methods utilize clearly-defined performance metrics for each chronic condition. We calculate everything from emergency room utilization rates to diabetes care testing compliance. We ll even show you actual levels of employee participation, including engaged and nonengaged employees.

5 Better. Faster. Stronger. Early Member Identification Equals Better Outcomes and Savings. The Patient: A member was diagnosed with diabetes and filled a prescription for metformin. She did not start taking the medication and was not monitoring her blood glucose. Intervention: Using pharmacy claims data, Medco immediately identified the member as a new diabetes patient. A nurse called her two days later and began coaching her on medication compliance and self-care. Result: The member began taking her medication and set a self-care goal to obtain a glucometer. This early identification and engagement provided needed education and prevented long-term, unnecessary, and costly complications down the road. The earlier we identify and engage someone with a chronic disease, the Better their care, the Faster their turn-around from crisis to stability, the Stronger their commitment to beneficial behavior change. WPS Chronic Care Management interventions often result in: Improved compliance with medication regimens and treatment plans. Fewer hospital admissions and emergency claims. Lower utilization of medical services. More appropriate care. Adoption of healthier behaviors. In the long run, you ll have healthier, more productive employees, and lower overall health care costs. The Right Chronic Care Management Program. Right Here for You. Since 1946, WPS mission has been to provide affordable, comprehensive health coverage for our friends and neighbors right here in Wisconsin. In today s health insurance marketplace, WPS Chronic Care Management delivers needed solutions to help employees reduce their health risks while lowering costs for employers. Contact your local agent to learn more about WPS Chronic Care Management. Or, call WPS at

6 1717 W. Broadway P.O. Box 8190 Madison, WI Wisconsin Physicians Service Insurance Corporation. All rights reserved Optimal Health and World s Most Advanced Pharmacy are registered trademarks of Medco Health Solutions, Inc. Health and Care Support is a registered trademark of Healthways, Inc. Self-funded groups using a pharmacy benefit manager other than Medco may experience different results. Ask your agent or WPS representative for details.

WPS Medical Management

WPS Medical Management Medical Management WPS Medical Management Controlling Costs through Compassionate Support Managing Costs. Improving Outcomes. Just one employee with catastrophic medical claims can send your health insurance

More information

WPS Pharmacy Services

WPS Pharmacy Services Medication Management Smart Rx. Today, prescription drugs are the fastest-growing category of health care costs.1 In the last 15 years, prescription drug prices have risen at almost triple the rate of

More information

Solutions. Health Advocate Chronic Care Management Program

Solutions. Health Advocate Chronic Care Management Program Solutions Health Advocate Chronic Care Management Program Taking Control Immunizations, preventive screenings and managing chronic conditions are key to controlling costs. Yet physicians often have limited

More information

Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases

Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic

More information

Concept Series Paper on Disease Management

Concept Series Paper on Disease Management Concept Series Paper on Disease Management Disease management is the concept of reducing health care costs and improving quality of life for individuals with chronic conditions by preventing or minimizing

More information

Member Health Management Programs

Member Health Management Programs Independent Health s Member Health Management Programs Helping employees manage their health. Helping you manage your costs. Independent Health s Member Health Management Programs A Comprehensive Approach...

More information

An Integrated, Holistic Approach to Care Management Blue Care Connection

An Integrated, Holistic Approach to Care Management Blue Care Connection An Integrated, Holistic Approach to Care Management Blue Care Connection With health care costs continuing to rise, both employers and health plans need innovative solutions to help employees manage their

More information

Carewise Health personal health management

Carewise Health personal health management Carewise Health personal health management Your guide to a healthier tomorrow National Elevator Industry Health Benefit Plan Live well Have you tried to improve your health in the past, yet didn t achieve

More information

Worksite Wellness. Keeping employees happy and healthy at work. Journey TO HEALTH

Worksite Wellness. Keeping employees happy and healthy at work. Journey TO HEALTH Keeping employees happy and healthy at work Worksite Wellness can facilitate onsite health and wellness offerings for employees. The programs can be used separately or as part of an integrated onsite wellness

More information

CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT

CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT HEALTH SERVICES AND PROGRAMS The Plan s Health Promotion and Disease Management Department seeks to improve the health and overall well-being of our

More information

More than a score: working together to achieve better health outcomes while meeting HEDIS measures

More than a score: working together to achieve better health outcomes while meeting HEDIS measures NEVADA ProviderNews Vol. 3 2014 More than a score: working together to achieve better health outcomes while meeting HEDIS measures We know you ve heard of Healthcare Effectiveness Data and Information

More information

Oxford Condition Management Programs: Helping your employees learn, be encouraged and get support

Oxford Condition Management Programs: Helping your employees learn, be encouraged and get support Oxford Condition Management Programs: Helping your employees learn, be encouraged and get support UnitedHealthcare is committed to helping improve the health and well-being of the individuals we serve

More information

Provider Manual. Section 18.0 - Case Management and Disease Management

Provider Manual. Section 18.0 - Case Management and Disease Management Section 18.0 - Case Management and Disease Management 18.1.1 Introduction 18.2.1 Scope 18.3.1 Objectives 18.4.1 Procedures Case Management 18.4.1-A. Referrals 18.4.1-B. Case Management Mercy Maricopa Acute

More information

Population Health Management Program

Population Health Management Program Population Health Management Program Program (formerly Disease Management) is dedicated to improving our members health and quality of life. Our Population Health Management Programs aim to improve care

More information

Colorado Small Business Enrollment Guide A BETTER WAY to take care of business

Colorado Small Business Enrollment Guide A BETTER WAY to take care of business 2015 SMALL BUSINESS HEALTH Colorado Small Business Enrollment Guide A BETTER WAY to take care of business Choose BETTER. 31 Important deadline Open enrollment begins on November 15, 2014 for coverage beginning

More information

Great Expectations for health Programs Employer Resource Guide

Great Expectations for health Programs Employer Resource Guide BlueChoice HealthPlan is more than just a health benefits plan. We have programs that target many specific health issues. We also participate in several quality programs: The National Committee for Quality

More information

Healthy Solutions for Life

Healthy Solutions for Life Healthy Solutions for Life 2015 Presentation Overview About Healthy Solutions for Life Disease Management Health Coaching Model DM Programs TeleCare Monitoring 2013 Nurtur Health, Inc. All Rights Reserved.

More information

Virginia s Healthy Returns Alternative Benefit Design

Virginia s Healthy Returns Alternative Benefit Design Virginia s Healthy Returns Alternative Benefit Design Presentation to the: National Governors Association s Center for Best Practices: State Defined Benefit Package Workshop Patrick W. Finnerty, Director

More information

Improving the Management of the Dual Eligible Population

Improving the Management of the Dual Eligible Population Improving the Management of the Dual Eligible Population Kathryn Eshelman, MD, MPH October 26, 2012 Discussion Objectives Since dual eligibles are often and increasingly members of risk adjusted, disease

More information

Shaping our future: a call to action to tackle the diabetes epidemic and reduce its economic impact

Shaping our future: a call to action to tackle the diabetes epidemic and reduce its economic impact Shaping our future: a call to action to tackle the diabetes epidemic and reduce its economic impact Task Force for the National Conference on Diabetes: The Task Force is comprised of Taking Control of

More information

Your guide to UnitedHealthcare

Your guide to UnitedHealthcare Your guide to UnitedHealthcare Face the future with confidence The benefits environment remains challenging. Uncertainty reigns as a wave of new regulation sweeps across the industry. Costs continue to

More information

Medicaid Health Plans: Adding Value for Beneficiaries and States

Medicaid Health Plans: Adding Value for Beneficiaries and States Medicaid Health Plans: Adding Value for Beneficiaries and States Medicaid is a program with numerous challenges, both for its beneficiaries and the state and federal government. In comparison to the general

More information

Wasteful spending in the U.S. health care. Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs

Wasteful spending in the U.S. health care. Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs Strategies for Changing Members Behavior to Reduce Unnecessary Health Care Costs by Christopher J. Mathews Wasteful spending in the U.S. health care system costs an estimated $750 billion to $1.2 trillion

More information

Engaging Patients in Their Health: HealthPartners

Engaging Patients in Their Health: HealthPartners Engaging Patients in Their Health: HealthPartners Too often, people are left on their own to manage an illness. At HealthPartners, the experience is different. HealthPartners health plan proactively reaches

More information

Self-Insured Schools of California:

Self-Insured Schools of California: Helping SISC III SELF-INSURED SCHOOLS OF CALIFORNIA Self-Insured of California: Helping Access+ HMO SaveNet 2013/2014 Enrollment Guide Blue Shield of California offers health benefits to school districts

More information

Telehealth Solutions Enhance Health Outcomes and Reduce Healthcare Costs

Telehealth Solutions Enhance Health Outcomes and Reduce Healthcare Costs Text for a pull out can go heretext for a pull out can go heretext for a pull out can go Text for a pull out can go here Text for a pull out can go here Telehealth Solutions Enhance Health Outcomes and

More information

Midwest ESOP Conference. September 11, 2015

Midwest ESOP Conference. September 11, 2015 Midwest ESOP Conference September 11, 2015 Why are you here today? I want to fix my company s healthcare problem Rising healthcare costs are: Negatively affecting my bottom line, EBITDA, stock price, etc

More information

MODULE 11: Developing Care Management Support

MODULE 11: Developing Care Management Support MODULE 11: Developing Care Management Support In this module, we will describe the essential role local care managers play in health care delivery improvement programs and review some of the tools and

More information

EMDEON INTERACTIVE CARE MANAGEMENT

EMDEON INTERACTIVE CARE MANAGEMENT EMDEON INTERACTIVE CARE MANAGEMENT Innovative Care Management Strategies for Payers Simplifying the Business of Healthcare Emdeon Interactive Care Management Innovative Care Management Strategies for Payers

More information

Approaches to Asthma Management:

Approaches to Asthma Management: Approaches to Asthma Management: BY CAROL MCPHILLIPS-TANGUM AND CAROLINE M. ERCEG ASTHMA IS A CHRONIC DISEASE that affects millions of people in the United States and disproportionately impacts children,

More information

Health Coaching Center of Excellence

Health Coaching Center of Excellence Health Coaching Center of Excellence Why Health Coaching? While physicians diagnose and treat illness, they don t always have the time to teach their patients to take proactive steps with nutrition, lifestyle

More information

For more information, please visit anthem.com/ca.

For more information, please visit anthem.com/ca. For more information, please visit anthem.com/ca. SpecialOffers is provided by Anthem Blue Cross as a service to our members. These services do not constitute benefits under Anthem Blue Cross plans and

More information

There are doctors who specialize in medical conditions. Now there are pharmacists who specialize in the medications used to treat these conditions.

There are doctors who specialize in medical conditions. Now there are pharmacists who specialize in the medications used to treat these conditions. There are doctors who specialize in medical conditions. Now there are pharmacists who specialize in the medications used to treat these conditions. A pharmacist who specializes in the medications used

More information

High Desert Medical Group Connections for Life Program Description

High Desert Medical Group Connections for Life Program Description High Desert Medical Group Connections for Life Program Description POLICY: High Desert Medical Group ("HDMG") promotes patient health and wellbeing by actively coordinating services for members with multiple

More information

CIGNA Small Group Business

CIGNA Small Group Business HEALTH BENEFIT SOLUTIONS 806774 11/06 CIGNA HEALTHCARE. PROTECTING THE HEALTH OF SMALL GROUPS IN A BIG WAY. Business owners with 50 or fewer employees face a big decision. How can they provide their employees

More information

Inspiring a Lifetime of Good Health and Well-being

Inspiring a Lifetime of Good Health and Well-being Inspiring a Lifetime of Good Health and Well-being Helping you protect the health of your employees and your bottom line against rising health care costs is the foundation of our total population health

More information

Maureen Mangotich, MD, MPH Medical Director

Maureen Mangotich, MD, MPH Medical Director Maureen Mangotich, MD, MPH Medical Director Prepared for the National Governors Association Healthy America: State Policy Leaders Meeting, December 2005 Delivering value from the center of healthcare Pharmaceutical

More information

Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification

Disease Management Identifications and Stratification Health Risk Assessment Level 1: Level 2: Level 3: Stratification Disease Management UnitedHealthcare Disease Management (DM) programs are part of our innovative Care Management Program. Our Disease Management (DM) program is guided by the principles of the UnitedHealthcare

More information

Change your perspective and watch your health care savings add up.

Change your perspective and watch your health care savings add up. 5537 Change your perspective and watch your health care savings add up. Let us show you how much you can save by exploring self-funding solutions. Welcome to the brave new world of benefits plans. The

More information

I. INFORMATION ABOUT THE DEMONSTRATION

I. INFORMATION ABOUT THE DEMONSTRATION EVALUATION DESIGN FOR THE WISCONSIN SENIORCARE SECTION 1115 PHARMACEUTICAL BENEFIT DEMONSTRATION I. INFORMATION ABOUT THE DEMONSTRATION This Evaluation Design is for project number 11-W-00149/5, the Wisconsin

More information

Breathe With Ease. Asthma Disease Management Program

Breathe With Ease. Asthma Disease Management Program Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program

More information

Aon Hewitt Health & Benefits Consulting

Aon Hewitt Health & Benefits Consulting Aon Risk Solutions Aon Hewitt Health & Benefits Consulting Better Health. Better Results. Risk. Reinsurance. Human Resources. Empower Results Game-Changing Strategies to Achieve Better Results As population

More information

CareManagement. Care You Can Count On. Pearson Benefits FOR TODAY AND TOMORROW BE INFORMED. GET CONNECTED. FOR YOUR BENEFIT.

CareManagement. Care You Can Count On. Pearson Benefits FOR TODAY AND TOMORROW BE INFORMED. GET CONNECTED. FOR YOUR BENEFIT. CareManagement Care You Can Count On Pearson Benefits FOR TODAY AND TOMORROW BE INFORMED. GET CONNECTED. FOR YOUR BENEFIT. Live your healthiest life by taking advantage of the care management programs

More information

Blue Shield of California Wellness Programs and Services

Blue Shield of California Wellness Programs and Services Blue Shield of California Wellness Programs and Services Helping you and your family on the way to better health The support you need for a healthier life Blue Shield s wellness programs and resources

More information

Reinsurance for Early Retirees Program

Reinsurance for Early Retirees Program Summary of Programs Disease Management CareFirst's approach to disease management seeks better management of members diagnosed with certain high frequency, high cost diseases through the early detection

More information

ACTIVELY MANAGED DRUG SOLUTIONS. for maintenance and specialty medication. Actively Managed Drug Solutions is not available in the province of Quebec

ACTIVELY MANAGED DRUG SOLUTIONS. for maintenance and specialty medication. Actively Managed Drug Solutions is not available in the province of Quebec ACTIVELY MANAGED DRUG SOLUTIONS for maintenance and specialty medication Actively Managed Drug Solutions is not available in the province of Quebec ARE YOU UNDERESTIMATING THE IMPACT OF CHRONIC DISEASE?

More information

Coventry Health Care of Florida. Special Needs Plan (SNP) Model of Care Annual Training

Coventry Health Care of Florida. Special Needs Plan (SNP) Model of Care Annual Training Coventry Health Care of Florida Special Needs Plan (SNP) Model of Care Annual Training 1 Course Overview The Centers for Medicare and Medicaid (CMS) require all contracted medical providers to receive

More information

Galen Healthcare Solutions Dragonfly

Galen Healthcare Solutions Dragonfly Galen Healthcare Solutions Dragonfly Remote Patient Monitoring / Patient Engagement Platform Steve Cotton / Product Manager Copyright 2011 Allscripts Healthcare Solutions, Inc. 1 Company Information Company

More information

Top reasons to become an AmeriHealth Caritas Iowa provider

Top reasons to become an AmeriHealth Caritas Iowa provider Top reasons to become an AmeriHealth Caritas Iowa provider becomeaprovider.amerihealthcaritas.com WHO WE SERVE Nationally AmeriHealth Caritas With our nationwide presence, serving more than six million

More information

Submission by the Irish Pharmacy Union to the Department of Health on the Scope for Private Health Insurance to incorporate Additional Primary Care

Submission by the Irish Pharmacy Union to the Department of Health on the Scope for Private Health Insurance to incorporate Additional Primary Care Submission by the Irish Pharmacy Union to the Department of Health on the Scope for Private Health Insurance to incorporate Additional Primary Care Services January 2015 1 IPU Submission to the Department

More information

Trish Riley, Director of Governor s Office of Health Policy and Finance Dr. Robert McAfee, Chair of the Dirigo Health Agency Board of Directors

Trish Riley, Director of Governor s Office of Health Policy and Finance Dr. Robert McAfee, Chair of the Dirigo Health Agency Board of Directors STATE OF MAINE DIRIGO HEALTH AGENCY 211 WATER STREET, 53 STATE HOUSE STATION AUGUSTA, MAINE 04333-0053 JOHN ELIAS BALDACCI GOVERNOR KARYNLEE HARRINGTON EXECUTIVE DIRECTOR TO: FROM: CC: Joint Committee

More information

Medicare Advantage Plans: An Overview

Medicare Advantage Plans: An Overview Medicare Advantage Plans: An Overview June 2014 Prepared by: Penny Finch, Benefits Consultant Copyright 2014 by The Segal Group, Inc. All rights reserved. 5432273.1 CONTENTS Medicare 101 Understanding

More information

Delta s Healthy Rewards Program. Administration Services

Delta s Healthy Rewards Program. Administration Services Delta s Healthy Rewards Program Administration Services Helping You Navigate the Winding Road of Healthcare Reform The crisis is real. Chronic diseases, such as diabetes and heart disease, are steering

More information

Solutions. Quality Service Plan Choice Value-Added Programs. for small business.

Solutions. Quality Service Plan Choice Value-Added Programs. for small business. Solutions Quality Service Plan Choice Value-Added Programs for small business. How does a small business attract and keep talented workers? One of the most important and attractive employee benefits an

More information

Note: This is an authorized excerpt from 57 Population Health Management Metrics. To download the entire report, go to

Note: This is an authorized excerpt from 57 Population Health Management Metrics. To download the entire report, go to Note: This is an authorized excerpt from 57 Population Health Management Metrics. To download the entire report, go to http://store.hin.com/product.asp?itemid=4817 or call 888-446-3530. 57 Population Health

More information

City of Tucson. Health and Wellness

City of Tucson. Health and Wellness City of Tucson Health and Wellness Did you know? That you have all of these CIGNA resources and programs FREE to you? 24/7 Customer Service Health Pregnancies, Health Babies Program Healthy Rewards Program

More information

health insurance changes Page 2 pharmacist better management Page 4 Get to know your Let s talk about Putting the care in care WINTER 2013 Page 6

health insurance changes Page 2 pharmacist better management Page 4 Get to know your Let s talk about Putting the care in care WINTER 2013 Page 6 WINTER 2013 Get to know your pharmacist better Page 6 Let s talk about health insurance changes Page 2 Kristin Weiler, Pharmacist Wayne Thompson Putting the care in care management Page 4 SECURITY HEALTH

More information

Great Expectations: Why Pharma Companies Can t Ignore Patient Services

Great Expectations: Why Pharma Companies Can t Ignore Patient Services Accenture Life Sciences Rethink Reshape Restructure... for better patient outcomes Great Expectations: Why Pharma Companies Can t Ignore Patient Services Accenture Research Note: Key findings from a survey

More information

Innovations@Home. Home Health Initiatives Reduce Avoidable Readmissions by Leveraging Innovation

Innovations@Home. Home Health Initiatives Reduce Avoidable Readmissions by Leveraging Innovation How Does CMS Measure the Rate of Acute Care Hospitalization (ACH)? Until January 2013, CMS measured Acute Care Hospitalization (ACH) through the Outcomes Assessment and Information Set (OASIS) reporting

More information

Chapter 8. Disease Management

Chapter 8. Disease Management Chapter 8. Disease Management 8.1 Introduction 2 8.2 Blues On Call SM 2 8.2.1 Program Overview... 2 8.2.2 Chronic Condition Support... 3 8.2.3 Treatment Decision Support... 4 8.2.4 Health Information and

More information

WHAT IS MEDICAL MANAGEMENT? WHAT IS THE PURPOSE OF MEDICAL MANAGEMENT?

WHAT IS MEDICAL MANAGEMENT? WHAT IS THE PURPOSE OF MEDICAL MANAGEMENT? WHAT IS MEDICAL MANAGEMENT? How health plans make decisions to approve payment for medical treatment is a poorly understood part of the healthcare system. One part of the process, known as medical management,

More information

Introducing UnitedHealthcare North Shore-LIJ Advantage When doctors connect, everyone benefits

Introducing UnitedHealthcare North Shore-LIJ Advantage When doctors connect, everyone benefits Introducing UnitedHealthcare North Shore-LIJ Advantage When doctors connect, everyone benefits For New York fully insured employers with 2-50 enrolled employees (Queens, Nassau, Suffolk counties) UnitedHealthcare

More information

DELIVERING VALUE THROUGH TECHNOLOGY

DELIVERING VALUE THROUGH TECHNOLOGY DELIVERING VALUE THROUGH TECHNOLOGY Mark Nelson, MD - EMR Physician Champion Krishna Ramachandran - Chief Information and Transformation Officer Karen Adamson - Director, Epic Clinical Applications DuPage

More information

Administering DTaP during the Shortage

Administering DTaP during the Shortage PROVIDER SERVICES Policies/ Procedures/ Claims HMO 215/567-3590 800/227-3119* PPO 800/332-2566 PHARMACY SERVICES Prescription Drug Authorization 888/671-5280 Toll-Free Fax 888/671-5285 Blood Glucose Meter

More information

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid

More information

LIFESTYLE RETURNS STEPS PROGRAM

LIFESTYLE RETURNS STEPS PROGRAM LIFESTYLE RETURNS STEPS PROGRAM ARE YOU READY TO GET ENGAGED IN YOUR HEALTH? We know that the way we live has a real impact on the way we feel. When we take care of ourselves, we have more drive and energy.

More information

Optum One. The Intelligent Health Platform

Optum One. The Intelligent Health Platform Optum One The Intelligent Health Platform The Optum One intelligent health platform enables healthcare providers to manage patient populations. The platform combines the industry s most advanced integrated

More information

October 22, 2014 Jill M. Gregoire RN, MSN Quality Assurance/Clinical Operations Director Indian Stream Health Center Colebrook, NH

October 22, 2014 Jill M. Gregoire RN, MSN Quality Assurance/Clinical Operations Director Indian Stream Health Center Colebrook, NH October 22, 2014 Jill M. Gregoire RN, MSN Quality Assurance/Clinical Operations Director Indian Stream Health Center Colebrook, NH Why Stratify Risk for Your Patients? NCQA s Patient-Centered Medical Home

More information

Special Needs Plan Provider Education

Special Needs Plan Provider Education Special Needs Plan Provider Education Reviewed September 2014 Learning Goals What is a Special Needs Plan (SNPs) What differentiates a SNP from other MA plans What SNPs are offered by Freedom Health and

More information

2012 Indiana Health Coverage Programs Annual Seminar. Care Select 101: Indiana Care Select Program Overview

2012 Indiana Health Coverage Programs Annual Seminar. Care Select 101: Indiana Care Select Program Overview PCS0144 (9/12) Mitchell E. Daniels, Jr., Governor State of Indiana Indiana Family and Social Services Administration 2012 Indiana Health Coverage Programs Annual Seminar Care Select 101: Indiana Care Select

More information

What privatisation means for Medibank. The increasing costs of the health system. Creating sustainability through a focus on health outcomes

What privatisation means for Medibank. The increasing costs of the health system. Creating sustainability through a focus on health outcomes IMPACT OF PRIVATISATION ON HEALTH INSURANCE Peter Derbyshire, General Manager of Strategy and Business Medibank Private Limited Development 1 The Medibank story What privatisation means for Medibank The

More information

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management Page1 G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify G.6 When to Notify G.11 Case Management Services G.14 Special Needs Services G.16 Health Management Programs

More information

Self-Insured Schools of California: SISC PPO

Self-Insured Schools of California: SISC PPO Helping SISC III SELF-INSURED SCHOOLS OF CALIFORNIA Self-Insured of California: Helping SISC PPO Administered by Blue Shield of California 2013/2014 Enrollment Guide Blue Shield of California is proud

More information

The Wyoming Pay for Participation Program for Medicaid Health Management

The Wyoming Pay for Participation Program for Medicaid Health Management The Wyoming Pay for Participation Program for Medicaid Health Management 2010 Medicaid Congress James Bush, M.D. State Medicaid Medical Officer Wyoming Department of Health Wyoming Medicaid- EqualityCare

More information

Section IX Special Needs & Case Management

Section IX Special Needs & Case Management Section IX Special Needs & Case Management Special Needs and Case Management 179 Integrated Care Management/Complex Case Management The Case Management/Care Coordination (CM/CC) program is a population-based

More information

October 2009 HEALTH PLAN CAPABILITIES TO SUPPORT VALUE BASED BENEFIT DESIGN

October 2009 HEALTH PLAN CAPABILITIES TO SUPPORT VALUE BASED BENEFIT DESIGN October 2009 HEALTH PLAN CAPABILITIES TO SUPPORT VALUE BASED BENEFIT DESIGN THE NATIONAL BUSINESS COALITION ON HEALTH GRATEFULLY ACKNOWLEDGES THE SUPPORT OF THE NATIONAL PHARMACEUTICAL COUNCIL FOR DEVELOPMENT

More information

NCQA Health Plan Accreditation. Creating Value by Improving Health Care Quality

NCQA Health Plan Accreditation. Creating Value by Improving Health Care Quality NCQA Health Plan Accreditation Creating Value by Improving Health Care Quality NCQA Health Plan Accreditation Creating Value by Improving Health Care Quality Purchasers, consumers and health plans pay

More information

HEALTH INSURANCE EMPLOYEE EDUCATION: PREVENTIVE CARE

HEALTH INSURANCE EMPLOYEE EDUCATION: PREVENTIVE CARE HEALTH INSURANCE EMPLOYEE EDUCATION: PREVENTIVE CARE Mott Community College Health Benefits Task Force DISCLAIMER The content in this presentation is informational. Each employee should review the benefit

More information

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions...

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions... TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 535.1 Member Eligibility and Enrollment... 2 535.2 Health Home Required Functions... 3 535.3 Health Home Coordination Role... 4 535.4 Health

More information

Healthy Living with Diabetes. Diabetes Disease Management Program

Healthy Living with Diabetes. Diabetes Disease Management Program Healthy Living with Diabetes Diabetes Disease Management Program Healthy Living With Diabetes Diabetes Disease Management Program Background According to recent reports the incidence of diabetes (type

More information

Anthem Balanced Funding 54626CABENABC 07/15. A new solution for health care spending and saving

Anthem Balanced Funding 54626CABENABC 07/15. A new solution for health care spending and saving Anthem Balanced Funding 54626CABENABC 07/15 A new solution for health care spending and saving Protecting the health of your employees we re all about that. Now let s protect the health of your business.

More information

Care Network of East Alabama, Inc.

Care Network of East Alabama, Inc. Care Network of East Alabama, Inc. Established in 2011 as a not-for-profit organization to promote the medical home and to address the needs of Patient 1st patients in east Alabama Timeline December 2010

More information

Clinical Nurse Specialists Practitioners Contributing to Primary Care: A Briefing Paper

Clinical Nurse Specialists Practitioners Contributing to Primary Care: A Briefing Paper Clinical Nurse Specialists Practitioners Contributing to Primary Care: A Briefing Paper As the need grows for more practitioners of primary care, it is important to recognize the Clinical Nurse Specialist

More information

Take your pills. Gaining the benefits of improved drug adherence. Life s brighter under the sun. September2014

Take your pills. Gaining the benefits of improved drug adherence. Life s brighter under the sun. September2014 September2014 Take your pills Gaining the benefits of improved drug adherence Join The Conversation, brought to you by Sun Life Financial Group Benefits. Life s brighter under the sun Take your pills Foreword

More information

Kaiser Permanente of Ohio

Kaiser Permanente of Ohio Kaiser Permanente of Ohio Chronic Disease Management Program March 11, 2011 Presenters: Amy Kramer and Audrey L. Callahan 1 Objectives 1. Define the roles and responsibilities of the Care Managers in the

More information

DIABETES DISEASE MANAGEMENT PROGRAM DESCRIPTION FY11 FY12

DIABETES DISEASE MANAGEMENT PROGRAM DESCRIPTION FY11 FY12 DIABETES DISEASE MANAGEMENT PROGRAM DESCRIPTION FY11 FY12 TABLE OF CONTENTS 1. INTRODUCTION.3 2. SCOPE........3 3. PROGRAM STRUCTURE...4 3.1. General Educational Interventions.....4 3.2. Identification

More information

Introducing. Accelerating employee engagement to drive healthier lifestyles

Introducing. Accelerating employee engagement to drive healthier lifestyles Introducing Accelerating employee engagement to drive healthier lifestyles Your goal is to keep employees healthy, happy, and more productive. Our goal is to help you achieve just that. In building a worksite

More information

Section C Implement One (1) Clinical Decision Support Rule

Section C Implement One (1) Clinical Decision Support Rule Office of the National Coordinator for Health Information Technology c/o Joshua Seidman Mary Switzer Building 330 C Street, SW, Suite 1200 Washington, DC 20201 Dear Mr. Seidman: On behalf of the American

More information

Maximize the value of your COPD population health programs with advanced analytics PLAYBOOK

Maximize the value of your COPD population health programs with advanced analytics PLAYBOOK Maximize the value of your COPD population health programs with advanced analytics PLAYBOOK STEP ONE: Analyze your patient population Bend the cost curve: Learning more about your patients can lead to

More information

Project HealthDesign:

Project HealthDesign: E-Primer 1 Project HealthDesign: Rethinking the Power and Potential of Personal Health Records A New Vision for Personal Health Records Health care institutions and software developers currently offer

More information

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Quality Management Program 2012 Overview Quality Improvement

More information

Home Health Care: A More Cost-Effective Approach to Medicaid in Illinois Illinois HomeCare & Hospice Council December 2010

Home Health Care: A More Cost-Effective Approach to Medicaid in Illinois Illinois HomeCare & Hospice Council December 2010 Home Health Care: A More Cost-Effective Approach to Medicaid in Illinois Illinois HomeCare & Hospice Council December 2010 As the Illinois Legislature prepares to act on the future of Medicaid, it is important

More information

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida

Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Medicare Quality Management Program Overview Quality Improvement (QI) Overview At Coventry, we

More information

MedStar Family Choice (MFC) Case Management Program. Cyd Campbell, MD, FAAP Medical Director, MFC MCAC June 24, 2015

MedStar Family Choice (MFC) Case Management Program. Cyd Campbell, MD, FAAP Medical Director, MFC MCAC June 24, 2015 MedStar Family Choice (MFC) Case Management Program Cyd Campbell, MD, FAAP Medical Director, MFC MCAC June 24, 2015 Case Management Program Presentation Overview CM Programs Disease Management Complex

More information

INDIVIDUAL HEALTHCARE MANAGEMENT: How to Help Employees Own Their Health

INDIVIDUAL HEALTHCARE MANAGEMENT: How to Help Employees Own Their Health INDIVIDUAL HEALTHCARE MANAGEMENT: How to Help Employees Own Their Health Michelle A. Gourdine, M.D. CEO and Principal Consultant Michelle Gourdine & Associates LLC A Healthcare Consulting Firm OBJECTIVES

More information

UCare provides case management for all UCare members not affiliated with one of the above listed care systems. 2011 UCare for Seniors

UCare provides case management for all UCare members not affiliated with one of the above listed care systems. 2011 UCare for Seniors Case Requirements Updated 3/16/2011 According to the Case Society of America (CMSA), Case Model Act of 2009, Case management is a collaborative process of assessment, planning, facilitation, care coordination,

More information

Modern care management

Modern care management The care management challenge Health plans and care providers spend billions of dollars annually on care management with the expectation of better utilization management and cost control. That expectation

More information

April 28, 2014. Submitted electronically via www.regulations.gov

April 28, 2014. Submitted electronically via www.regulations.gov April 28, 2014 Department of Health and Human Services Office of the National Coordinator for Health Information Technology Attention: 2015 Edition EHR Standards and Certification Criteria Proposed Rule

More information

Realizing ACO Success with ICW Solutions

Realizing ACO Success with ICW Solutions Realizing ACO Success with ICW Solutions A Pathway to Collaborative Care Coordination and Care Management Decrease Healthcare Costs Improve Population Health Enhance Care for the Individual connect. manage.

More information

The Primary Health model: A collection of population health solutions & services

The Primary Health model: A collection of population health solutions & services The Primary Health model: A collection of population health solutions & services Creating health care alignment with an employer-driven network The United States spends more money on health care than any

More information