Care Management Services

Health Management

Statistics

• By the year 2010, chronic diseases will out number infections.
• More than 90 million Americans are projected to live with chronic illnesses.
• Medical costs associated with the treatment of chronic diseases attributes to 78% of the Nation’s total medical expenditures.

Health Management Involves:

• Health Risk Identification and Evaluation
• Health Coaching
• Education
• Support
• Behavior Modification
• Encouragement
• Positive Reinforcement
• Professional Collaboration

Objectives of Health Management

• Improve member knowledge and self-management of the chronic condition.
• Improve proper use of appropriate medications, self-monitoring, and to facilitate appropriate lifestyle changes.
• Improve adherence to recommended clinical practice guidelines.
• Track and measure the patient’s clinical outcomes.
• Promote healthy lifestyle habits to effect overall state of health, and physical well being.

How Does Health Management Work?

Personal Relationships – members have a relationship with an assigned health coach (RN).

Follow up – nurses actively engage the member to take a proactive role in personal healthcare self-management.

On-going Intervention:

• Health Fairs
• Structured Health Management Programs
• On-site Nurse Visits
• Website Access
• Newsletters

Which Chronic Conditions Are Addressed?

• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
• Diabetes
• Coronary Artery Disease (CAD)
• Congestive Heart Failure (CHF)

How Are Members Identified?

• Member diagnosis is identified using paid claims data and prescription vendor data.
• Through UR and CM Case Referral
• Health Risk Assessments
• Health Screenings
• Patient Self-Referral
• Questionnaires With Enrollment Information

Health Management Employer Incentives

• Long term savings can be found in reduction of insurance premiums and short term disability payouts.
• Significant indirect savings can also be found in reduced absenteeism, presenteeism, and increased productivity.
• Initial investment in the Health Management Program can be significant, but improved quality of life is worth the undertaking.

Our Goal

• To help employers create a culture that promotes health, and ultimately save healthcare dollars.
• Containment health care costs.
• Prevent expensive complications of chronic diseases.
• Assist your employees to acquire healthier lifestyle behaviors.
• Improve quality of life.
• Reduce negative influence and correlation of chronic illness in the work environment.


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