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 Disease Management
Disease Management Program Overview
Care1st Health Plan of Arizona provides a Disease
Management program to assist health professionals and providers in managing
members diagnosed
with targeted chronic illnesses. When not managed
through coordinated strategies, these conditions frequently result in
hospitalizations and/or
medical complications that require greater utilization
of resources and higher costs.
The chronic diseases Care 1st is focusing on are:
Members are identified by:
- ICD-9 codes
- Ancillary data, including laboratory studies with
specific lab values
- Medication history
- Hospitalizations
- Health Plan Employer Data and Information (HEDIS)
- Physician Profile
The disease management process is as follows:
- The disease management nurse makes initial contact with
identified member via
telephone and completes a comprehensive initial assessment.
- The disease management nurse determines from
the assessment if the member is
placed into the program. Areas considered for enrollment
are:
a. Elevated lab values
b. Need for education
c. Need for follow-up with primary care physician
d. Need for specialist referrals
e. Need for equipment
- Interventions utilized to manage members enrolled
in the program are as
follows:
a. Educating members about the disease, its
symptoms and effective tools
for self-management
b. Assisting members with enrollment in existing
education classes if
available
c. Educating members on medications
d. Assisting members with appointments with
primary care physician
e. Assisting members with referrals to specialists
f. Assisting members in obtaining equipment
covered under the plan
- Members in the program will be followed
at 1, 3, and 6 month intervals or more frequently
to monitor effectiveness of interventions.
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