Empowering seniors to take responsibility
Case managers work with members on issues
The goal of Health Net's Special Needs Plan for seniors with elevated cholesterol is to empower the members to become more informed and responsible for their own medical care in cooperation and collaboration with their physicians, says Richard Jacobs, MD, MBA, chief medical officer for Health Net of Arizona Inc.
"Our nurses work with members and their physicians to ensure that evidence-based standards of care are made available to the member. We educate and coach the member to facilitate improved medical compliance. The coaching is individualized for each member, depending on his or her personal health care needs and problems," he adds.
When members join the plan, they complete a health questionnaire that helps determine what individualized services they need, Jacobs says.
New members with established cardiac disease are screened for appropriate medications, such as the use of beta-blockers.
The nurses and social workers who manage the care of the members are backed by board-certified physician medical directors.
Typical interventions include enrolling members in smoking cessation programs, educating them on the benefits of taking their medications, working with physicians to ensure that key medications and treatments are made available to the member, and coordinating appointments with specialists.
Nurses and social workers are available to answer questions and concerns and to help the members overcome obstacles to care.
Health Net uses national cholesterol education programs as its guideline for the program.
"We don't just manage the cholesterol. If they are smokers, they get smoking cessation education; if they are diabetics, they receive full-service disease management and case management across the spectrum," he says.
Health Net also has launched a Special Needs Plan for seniors with high cholesterol in Oregon, Washington, and Connecticut.
Each state take a slightly different approach to managing cholesterol but all the plans include education and health coaching, Jacobs says.
In Arizona, where the first cholesterol special needs plan was launched, the health plan partnered with a vendor that specializes in disease management for seniors to administer the plan.
Members who sign up for the program fill out a health risk assessment questionnaire that stratifies their risk level.
Members at high risk receive outreach calls from nurse health coaches who help them become compliant with their medication regimen and their individual treatment plan.
The vendor analyzes pharmacy claims several times a year to identify members who have not gotten their medications filled.
If people are not getting their medication filled, the vendor's health coaches contact the members and work with them to ensure adherence and alert the physician that the member has not filled his or her prescription.
Beneficiaries who sign up for the high cholesterol special needs plan remain in it indefinitely.
"The nurses never stop working with these members. We are constantly monitoring their utilization of the cholesterol-lowering drug. If they fail to fill a prescription, the nurses get back in touch with them and get them back on track," he says.
The health plan doesn't receive any additional reimbursement from Medicare to provide the extra services, Jacobs points out.
"We feel that in the long run everybody will benefit. The beneficiaries will stay healthier and it may prevent coronary conditions that would cost the health plan much more," he says.
The goal of Health Net's Special Needs Plan for seniors with elevated cholesterol is to empower the members to become more informed and responsible for their own medical care in cooperation and collaboration with their physicians, says Richard Jacobs, MD, MBA, chief medical officer for Health Net of Arizona Inc.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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