August 3, 2009
Vol. II, No. 7
Case Managers Play Key Role in South Carolina
Medical Home Pilot for Diabetics
In the first three months of a year-long PCMH pilot for diabetics in South Carolina, case managers have contacted 60 percent of eligible patients to explain the concept, gather baseline health data and encourage use of an online portal whose tools help them to manage their disease and have e-visits with a physician. Patient response is positive to outreach by the case managers, whose aim is to reduce gaps in care, such as missed appointments with specialists, and handle lifestyle issues like medication adherence. The case managers also register patients for diabetic education, schedule appointments with specialists, provide discount vouchers for medications and exercise programs and monitor quality processes and outcomes measures to help increase patient compliance. There is no copayment or extra charge to the patients for participation in the pilot.
The project, which completed its first quarter with 1,110 patients enrolled, focuses on diabetic patients who are members of BlueCross BlueShield of South Carolina, BlueChoice HealthPlan of South Carolina and the State Health Plan and who are patients of Palmetto Primary Care Physicians in the Charleston, S.C., area.
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Premera Blue Cross has partnered with Swedish's new Community Health Medical Home Clinic in Seattle to offer its members unlimited access to physician teams — including 30- to 60-minute visits and phone and e-mail access — that provide not only preventive care, but also wellness services, chronic disease management and other health services. Patients at the family medicine clinic at Swedish/Ballard can access their own medical charts through a secured Web site. Swedish's Web-based service also allows patients to request medical appointments, view their health summaries from the EHR, request prescription renewals and communicate electronically and securely with their medical care team.
Swedish is waiving co-pays for visits by participating Premera members. Additionally, the payor and provider have agreed on an innovative model of reimbursement for care provided at the clinic that will emphasize quality of care and healthy patient outcomes – including incentives for Swedish in delivering quality care to Premera’s participating members.
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Patient education is one of payoffs of a successful medical home partnership. Educating patients about their health conditions, plan of care and wellness and prevention strategies not only empowers them to manage their condition and care but also can reduce medical complications, medication costs and unnecessary healthcare utilization. Complete HIN's Survey of the Month on Patient Education and Engagement by August 31 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
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Providing Caregiver Education and Support
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