Care1st Health Plan - Quality Improvement - Care1st Cares Programs

Care1st Health Plan has implemented this program that provides in-home physician visits for our highest risk members. The physician group providing these services is called Care Level Management (CLM), a nationally recognized company that provides in home physician visits or “house calls” to select members with chronic health conditions.

Care1st Health Plan is offering this program to a small number of select Care1st members with complex or chronic medical conditions. These in-home visits are designed to support your efforts and help keep these vulnerable members out of the ER and the hospital. These visits are free to the member. They do not replace the office- based primary care visits.

Program Details:

Members will continue to see the PCP in their office as often as needed. The CLM physician will work closely with the PCP to help coordinate care. CLM does not replace the Primary Care Physician, but rather support your efforts to manage these complex members with multiple needs.
The patient is assigned to a specific CLM physician who gets to know him or her. The CLM physician will help the patient to manage his or her existing conditions and may help to prevent the onset of new ones.
The CLM physician can visit the member’s home any time as needed. The patients have direct phone access to the CLM physician 24 hours a day, 7 days a week.
The CLM physician will see the member at least once a month for regular scheduled visits and more often as needed. He or she can help the member with planned medical treatment while updating the PCP and other involved physicians on the member’s status.

Once the member consents to enroll in the program, CLM schedules the first visit with the assigned Personal Visiting Physician. Additional visits will be scheduled as needed.

Care1st CARES **
Care 1st has expanded its disease management programs, which will now be collectively known as Care1st CARES. In addition to Alere which runs our Asthma program, we have joined forces with Healthways, Inc to help implement and administer our newly expanded programs. These include Coronary Artery Disease and CHF for MediCal, and CHF and COPD for Medicare.

Asthma Program
The Alere Asthma Program provides a comprehensive plan for members with asthma. The program will maximize patient impact by focusing on several key areas:

Alere’s specialized respiratory Registered Nurses complete an initial comprehensive assessment asking members a series of specific clinical and demographical questions to determine the appropriate level of support. Based on this assessment and in conjunction with the member’s treating physician(s), interventions are determined based on a member’s symptoms and preferences. Members may move between program levels as necessary.

Identification of eligible patients is made possible through medical and pharmacy claims analysis, or via direct referral from physicians and case managers. An eligible patient with documented or probable asthma will be identified and then stratified into high, moderate or low risk via a clinical assessment.

Clinical interventions are supported by the NHLBI Guidelines for the diagnosis and management of asthma and the program interventions include:

Comprehensive Nursing Assessment to determine appropriate level of intervention.
Individualized Action Plans which describe self-assessment and management strategies for all levels of severity and are coordinated with the PCP’s recommendations.
Proactive outbound calls to participants reviewing methods to identify and avoid triggers and positive behavior change reinforcement.
Assessment for individual and second-hand tobacco exposure.
Peak Flow meter and education on its correct use.
Reactive inbound calls from participants under stress.
Physician/Case Manager summary reports.
Full educational program including tailored education calls and a series of asthma education booklets.

Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary Disease (COPD) Programs

We have partnered with Healthways, Inc who has over 20 years experience providing specialized disease management programs and services. Care 1st and Healthways will use medical/pharmacy claims data to identify members that meet program enrollment criteria.
PCPs and specialists will also be able to refer members by completing a referral form.

Health Guides & Tools - Throughout the year, you will be sent valuable educational resources to help manage your condition. These materials include:

Healthy Newsletters & Reminders - Your patients may receive newsletters and reminders that will:

Updates on the latest breakthrough treatments
Reminders to your patients about important exams, and
Share lifestyle changes that could make a difference in your patients health, and more.

Support Available Monday - Saturday - Highly trained care team professionals will:

Review your patients health status.
Discuss your patients condition with them.
Help with lifestyle changes.
Contact your patient once in a while by phone to assist them with the management of their condition, and
Answer any questions they may have have.

If your patients have any of these conditions someone from the program may call them to talk about the program. If you wish to refer a Care1st patient to any of these programs please click here to access our referral form.