Philip Bonaparte, M.D., chief medical officer for Horizon NJ Health, discusses how to create a successful disease management program, and the possible challenges that could arise with a program when working with the Medicaid population.
Certain populations present their own challenges when it comes to complying with a Disease Management (DM) program. The Medicaid population is one of the most popular groups of individuals where a DM program should be provided. However, one of the challenges that could arise with the Medicaid population is locating the member and being able to have contact with that member. The majority of the information that healthcare organizations get from the state is usually inaccurate. That is not the fault of the state, although the organization can streamline that process and have systems that talk to each other. Addresses and phone numbers for these members are usually outdated. In addition, these members either don’t have phones or the wrong phone number is listed. When it comes to letters and regular mailings, those are often inadequate, in which case this method to administer DM programs would be somewhat ineffective. The return mail rate is very high compared to that of commercial plans.
To ensure that a DM program is effective, identify the population and make sure that the approach is disease-specific. For example, if a healthcare organization’s focus is on asthma, they should make sure that they have asthmatics in their population. Use population identification processes with evidence-based practice guidelines while at the standard of care. This is supported by studies and is considered to be standard medical practice. Another component is collaborative practice models that include physicians and support service providers.
The doctor or the nurse practitioner (NP) has to be involved. DM programs are ineffective if buy-in does not exist from the physicians or providers who are directly involved in the care of that patient. Patient self-management education is another major component of DM. This is not only important to disseminating medical information, but for education in general. It is a process of education where information is broken down to a level that the member can understand. In many cases, the member should provide feedback in order to show that they are not just agreeing with what their doctor or NP is saying, but that they really understand the material that is being presented to them. Process and outcomes measurement, evaluation in management and routine reporting and feedback are also crucial components of DM.
Challenges with the Medicaid population can continue with health risk assessments (HRAs) that are conducted upon enrollment to the plan for those that organizations make contact with. Healthcare organizations go through an assessment and then they put them in certain DM programs based on information that is provided from that interview.
Also, another challenge is making contact with members. Some organizations utilize the emergency room (ER) and pharmacist and professional offices to gain such contact. They try any legal method that they can to reach out to members. In 2003, Horizon New Jersey Health implemented an on-site ER program in their busiest ERs and they now have that program in three other ERs and are planning a fourth site. There has been a significant reduction in repeat visits for Horizon and a corresponding increase in outpatient utilization of both the primary care providers, specialists, pharmacy, labs and radiology services for members who are touched by the on-site staff.
Source: Delivering Disease Management to Medically Underserved Populations Plus 21 Strategies for Making and Keeping Contact with Hard-to-Reach Clients, December 2007
Delivering Disease Management to Medically Underserved Populations Plus 21 Strategies for Making and Keeping Contact with Hard-to-Reach Clients
This 46-page special report highlights how many organizations are employing novel methods to make contact with Medicaid and Medicare beneficiaries, the categorically needy and others and engaging them in successful disease management (DM) programs.
Delivering Disease Management to Medically Underserved Populations Plus 21 Strategies for Making and Keeping Contact with Hard-to-Reach Clients is available from the Healthcare Intelligence Network for $157 by visiting our
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