2011 Health Management Program Performance
Health Management programs that are offered to members include:
- Chronic Obstructive Pulmonary Disease(COPD)
- Back Care
Each program offers tools and resources to support members and caregivers with managing chronic disease. Some examples include, but are not limited to:
- On- line physician clinical practice guidelines available for download to assist in monitoring member care. These guidelines are also made available in paper copy when requested
- Member self management tools (ex: free glucometers) and educational materials are available from the clinical staff at the plan and on our web site
- National resources are available on our web site(ex: American Diabetes Association)
- Members are sent gap in care notices which addresses lack of necessary screening tests related to specific conditions, such as, Asthma, COPD, Diabetes and Cardiac disease.
- Community classes and worksite wellness programs are available to promote behavior changes such as smoking cessation, weight loss and exercise.
- Availability of enrollment into a disease management program for one on one telephonic interaction with a nurse or health coach
Our health management teams include nurses, social workers, chiropractors, outreach workers, dieticians and health coaches. Health Care Effectiveness Data and Information Set (HEDIS) measures are a national scoring, of important elements in health management, similar to a report card, that measures quality of care and compares local health plans. This also measures Quality of Care, Access to Care and Member Satisfaction with the Health Plan and physicians. This oversight of our health management programs monitors members needs, and the success of the programs. This is completed on an ongoing basis, and the programs are measured and documented completed at least annually.
Results for 2011:
In the HEDIS results for use of appropriate medications, rates for the population remain at or are above state and national averages .Current interventions in place are effective and meeting the needs of the membership based on the results.
Chronic Obstructive Pulmonary Disease (COPD)
Spirometry testing and medication management rates are measured to determine program success. There has been a significant increase in the Commercial and Medicare populations for the Use of Spirometry testing measure. Corticosteroid (steroid) management rates are well above state and national averages. Bronchodilator rates for the population meet the national average.
We utilize the HEDIS measure for Use of Imaging Studies for low back pain (LBP) to monitor the care our enrollees receive. These rates have improved for all lines of business. Current interventions in place are effective and meeting the needs of the membership based on the results.
There are eight specific HEDIS diabetes measures to monitor the care our members receive. Many of these measures have shown improvement over the last three years. Targeted member interventions are in place to improve HgbA1C (hemoglobin level) and LDL (cholesterol) levels.
We focus our efforts on members with diabetes, high blood pressure and elevated cholesterol levels. New interventions encourage members to comply to medication management. These efforts have resulted in improved cholesterol levels in our population.