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Premera Blue Cross DM Program Cuts Time Needed To Identify Who Can Be Helped By DM

Premera Blue Cross introduced a significant enhancement of its disease management (DM) program that reduces the time needed to identify members who can benefit from DM from an industry average of 120 days down to a range of 10-14 days for certain conditions.

According to research conducted by Healthways Inc., Premera’s DM vendor, members incur two to four times more hospital admissions, emergency room visits and healthcare costs in the first 90 days after diagnosis than later in their course of care. During this period a member’s monthly healthcare costs are 44 percent higher than later in their care.

Under the enhanced approach to member engagement newly diagnosed members are identified in days instead of months after initial diagnosis. Premera now can reach out to these members earlier in the care process and positively affect their health status and reduce overall healthcare costs.

The program enhancement is made possible by an arrangement between Healthways and Medco Health Solutions Inc. which reviews and sends relevant pharmacy data from Medco directly to Healthways. Through this process, Premera’s disease managers immediately reach out to members newly diagnosed with certain conditions by their pharmacy claims, Premera said.

The benefit to Premera members goes beyond faster outreach. The research also suggests that members newly diagnosed with certain chronic conditions will have a better long-term prognosis if they receive assistance soon after their initial diagnosis.

Premera’s DM program offers clinical support to more than 55,000 members managing chronic conditions, such as heart disease, diabetes, and asthma.

Address: Premera Blue Cross, 7001 220th St. SW, Mountainlake Terrace, WA 98043; (425) 670-4000,

The Executive Report on Managed Care, November 15, 2007

© 2007 The Managed Care Information Center

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