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OptumHealth Treatment Decision Support Program, OptumHealth
Gail Croall, MD - Natational Medical Director, HCDS, OptumHealth
Treatment Decision Support (TDS) provides a foundation of consumer-centric informed decision making. The nurse identifies the consumer’s needs and preferences, and then engages and motivates the consumer to become a more active participant in their health care decisions. TDS identifies the need for referrals to physicians and facilities likely to yield the best treatment outcomes and helps consumers prepare for treatment and follow-up care.
Aetna’s Health Care Transparency Initiative, Aetna, Inc.
Lisa Carrara, Head of Aexcel Product Development, Aetna
Aetna is paving the way by providing its members with tools and transparent health care cost and clinical quality information to help them take an active role in making better decisions about their health care and spending. Aetna’s response to the growing need for physician and facility-specific price and clinical quality information encompasses three specific web-based resources which continue to expand over time.
Sensei for Weight Loss, Sensei, Inc., a Humana Joint Venture
Robert Schwarzberg, MD, CEO, Sensei, Inc.
Sensei launched its first product, a mobile-phone-based program for weight management, in November 2007. Sensei for Weight Loss™ transforms a consumer’s mobile phone into a “personal digital coach” (PDC) that delivers customized meal recommendations, fitness information and motivational messages – in real time, throughout the day, when consumers need the help most. Having Sensei is like having a nutritionist and a personal health coach with you all the time.
Exposure Hotline of Centra Care and FONEMED, FONEMED and Centra Care
Ken Bleakley, President
Lorraine McInerney, BSN, RN, LWCA, LHRM, Senior Manager, Centra Care Business Health Services, Florida Hospital/Centra Care
The Occupational Medicine Division of Centra Care of Adventist Hospital Systems developed a toll-free Exposure Hotline that has grown to include city and county municipalities, other hospitals, correctional institutions, long-term-care
facilities, drug rehab centers, free-standing surgical centers and physician and dental offices. FONEMED operates the 24/7 call center along with specially trained Registered Nurses.
Blue Care Connection: Closing the Gaps in the Obesity Epidemic, Blue Cross Blue Shield of Texas
Kathy Gonzalez, Director of Blue Care Connection/Acct Mgmt Clinical Support, BCBS of Texas
Freda Hanley, Sr. Manager BCC/Disease Management, BCBS of Texas
Obesity has been recognized to be a challenging and significant risk factor for many chronic diseases. Using a multidisciplinary team approach, the Blue Care® Connection Program of Blue Cross Blue Shield of Texas developed a Lifestyle Management/Obesity outreach program to support participating members and their physicians, enabling members to take responsibility for their health through weight management education and supportive intervention.
Improving Patient Safety for Diabetic Patients, Medco Health Solutions, Inc.
Lon Castle, MD, Senior Director, Medco Health Solutions
Barry Cesanek, RPh, Director of Pharmacy
Practice, Medco Health Solutions
Ellen Franzblau-Isaac, RN, BSN, MPA,
Director, Clinical Program Development, Medco Health Solutions
Susan Peppers, Pharmacist Supervisor, Medco Health Solutions
Amanda Stidam, Medication Safety Analyst,Medco Health Solutions
Using a new pharmacy practice model, the safety and quality of treatment for patients with diabetes was improved. The primary changes to standard practice are the intensive disease-specific training provided to the pharmacists, the segmentation and routing of prescriptions to pharmacists with the appropriate specialization, and the in-depth counseling provided to patients. Evaluation of this new personalized pharmacy practice model determined what impact specialization had on helping patients manage their diabetic condition. |
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Health Care Management
BH Home Intervention Impact on Readmissions, PsycHealth, Ltd.
Bruce Gomez, LCSW, Director, Clinical Services, PsycHealth, Ltd
Melinda Swank, LCPC, Clinical Care Coordinator, PsycHealth, Ltd.
The PsycHealth, Ltd. Home Intervention Program (HIP) is an alternative outreach outpatient modality which provides assessment and therapy in the patient’s home as opposed to the traditional clinical office setting. Its mission is to reach and engage members who otherwise would have failed outpatient follow-up, especially post- hospitalization. In doing so, HIP attempts to decrease barriers to treatment, improve continuity of care, decrease relapse, and improve clinical outcomes and patient satisfaction
Health Information Technology
My HealtheVet, Department of Veterans Affairs
Kim Nazi, FACHE, Management Analyst, United States Department of Veterans Affairs
The Department of Veterans Affairs (VA)’s My HealtheVet award-winning e-health, online web portal launched nationwide in 2003. Today, My HealtheVet offers its 500,000+ users online tools to become better partners in their health care. With My HealtheVet, America’s veterans have access to personal, secure, convenient and informed personal health information that not only improves their health but encourages them to become partners in their health care.
Health Plan
Adolescent Immunization Community Collaborative, BlueCross BlueShield of Kansas City and Prime Solutions, Inc.
Shelley Bowen, Assistant Vice President, Quality Management , BlueCross BlueShield of Kansas City
Anne Hackman, CEO, Prime Solutions, Inc.
In 2004, few BCBSKC 13-year-old members received the five recommended vaccinations, with results far below the national rate of 45 per cent. Other local health plans were experiencing similarly low rates. BCBSKC worked with the Missouri QIO and Prime Solutions to mobilize a public-private partnership within the five-county, bi-state Kansas City metropolitan area. Over 40 public and private agencies committed to an 18-month effort through a new Adolescent Immunization Collaborative, with active participation by virtually all the area health departments, health plans and school districts.
Pharmacy Benefit Management
Improving ACE-I Utilization in Medicare Part D, MemberHealth, LLC
Alan Pendergrass, Manager, Analytics and Outcomes, MemberHealth, LLC
Jackie Raskind, PharmD, Clinical Pharmacist,MemberHealth, LLC
Katherine Thweatt, MA, EdD, Senior Manager, Clinical Quality,MemberHealth, LLC
MemberHealth’s project, “Improving ACE-I Utilization in a Medicare D Population,” used evidence-based guidelines to promote coordinated care when managing the chronic disease diabetes. Through analyzing patient claims data, MemberHealth identified ACE-I/ARB omission in the treatment of diabetics and successfully linked otherwise disconnected disciplines within the health care system: the prescription drug plan, the prescribing physician and the pharmacist.
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Health Care Management
Care Management Impact on Advance Directive Completion, ParadigmHealth
Albert E. Holt, IV, MD, MBA, Chief Medical Officer of Complex Care, Paradigm Health
Maureen Howard, RN, BSN, M.Ed., Director, Clinical Education, Paradigm Health
ParadigmHealth’s “Care Management Impact on Advance Directive Completion and Site of Death” addressed the inadequate communication of patient preferences for end-of-life care which impacts patients’ emotional well-being and utilization of health care resources. This quality initiative included review and revision of all case management goals related to terminal care planning to better reflect the impact that case management interventions have upon end-of-life outcomes for patients and families.
Health Information Technology
Behavioral Pharmacy Management Program, Eli Lilly and Company, Comprehensive NeuroScience, Inc. and Missouri Department of Mental Health
John P. Docherty, MD, President and CEO,Comprehensive NeuroScience, Inc.
George Oestreich, B.Sc. (Pharm.), P.Ph., MPA, Pharm.D., Director of Pharmacy , Missouri Department of Social Services
Joseph O'Hara, Chief Operating Officer, Comprehensive NeuroScience, Inc.
Joseph J. Parks, MD, Medical Director, Missouri Department of Social Services
Funded by Eli Lilly and Company, the award-winning BPM program, offered by Comprehensive Neuro-Science Inc., analyzes the prescribing of mental health medications for Medicaid patients. In executing the program, the state and CNS work together to identify patterns that are inconsistent with national, evidence-based guidelines. The ultimate goal is to improve patient care while helping ensure the most efficient use of taxpayer dollars in the Medicaid program.
Health Plan
The Washington Medicaid Integration Partnership, Molina Healthcare of Washington and Department of Social and Health Services of Washington
Daniel Kent, MD, FACP, Medical Director, Molina Healthcare of Washington, Inc
Joyce Cadwell, RN, BSN, Director of Special Programs, Molina Healthcare of Washington, Inc
The Washington Medicaid Integration Partnership (WMIP) is an “Integrated Care Coordination” intervention for aged, blind or disabled Medicaid clients in Snohomish County, Washington. WMIP is a partnership between the state’s
Department of Social and Health Services (DSHS) and Molina Healthcare of Washington, Inc. (Molina Healthcare). DSHS integrated several programs into one contract, and Molina Healthcare began providing coordination of care and benefits
for enrolled clients in 2005. WMIP benefits integrate coverage for medical care, treatment for substance abuse or mental health problems, and long-term care support.
Pharmacy Benefit Management
Geriatric RxMonitor Program, Prescription Solutions
Brian K. Solow, MD, Medical Director, Prescription Solutions
Prescription Solutions’ Geriatric RxMonitor Program is designed to reduce the use of potentially “inappropriate” medications among people 65 years of age or older. The program relies upon education and provision of patient-specific reports to providers to promote safe and appropriate use of medications by alerting them of “drugs to be avoided in the elderly”, as defined by HEDIS data. |
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Health Information Technology
Helping Consumers Close Gaps in Their Health Care, ActiveHealth Management
Stephen Rosenberg, MD, MPH, Senior Vice President for Outcomes Research, ActiveHealth Management
Clinical alerts can increase the use of evidence-based services by providing information on important services that appear to be missing from a patient’s treatment. But, when alerts are only sent to physicians, these improvements often
do not reach optimal levels. ActiveHealth Management’s Member Messaging Program addresses this constellation of needs: supplementing a physician clinical alert system with information sent directly to consumers concerning specific safety risks and other gaps in their care.
Health Plan
Post Hospital Discharge Call Process, Martin’s Point Health Care
Honora Jones, RN, BSN, CCM, Case Management Supervisor, Martin’s Point Healthcare
Archana Mahimkar, MS, MBA, Health Services Researcher, Martin’s Point Healthcare
A Six Sigma project to identify medical expense optimization opportunities for the health plan recommended proactive outreach by case management with a post-hospital discharge call to members. A post-hospital discharge assessment tool (questionnaire) was developed to evaluate a member’s likelihood of adhering to their care plan and to identify potential problems or gaps in care that could lead to a readmission. This post-hospital discharge call process promotes continuity across care settings, increases care coordination, supports patient safety and contributes to increased patient satisfaction.
Pharmacy Benefit Management
Express Scripts Generics Today, Express Scripts
Jeff Eichholz, PharmD, Director, Trend Management, Express Scripts
Express Scripts is dedicated to encouraging patients to use generic medications when clinically appropriate to hold down the spiraling costs of prescription drugs. To support this initiative ESI introduced Generics Today, a behavior changing outreach model, offering financial incentives, tailored communications showing personalized savings opportunities and one-to-one phone assistance timed to coincide with the new savings opportunity.
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