TARRYTOWN, NY – As the chosen pilot site, Hudson Health Plan implemented the Case Management Society of America’s guidelines and Web-based tracker in June 2006.
A year later, the managed care organization has earned CMSA’s Award for Excellence in Adherence Management and enjoys member satisfaction and clinical staff adoption.
A recent survey revealed that members in the pilot cited the improved system as instrumental in getting them to take their medications as prescribed, according to Margaret Peggy Leonard, vice president of clinical services for Hudson Health Plan.
Nurses reported being better prepared to help their patients, she added.
Hudson hopes to look at members’ prescription use and ER and hospital visits to determine clinical outcomes.
Cheri Lattimer, executive director for CMSA, said the pilot will help CMSA evaluate the impact of its guidelines.
Nurses are equipped with more in-depth motivational and interviewing skills. “It’s a different way of posing questions,” said Leonard. “It provides a different way of talking to members.”
The CMAGTracker helps nurses assess patients in four areas: health literacy, medication knowledge, motivation (confidence) and readiness to change behavior.
The scoring identifies where the potential resistance to compliance lies.
“The barrier could be as simple as religion or language,” said Lattimer. “Until we really understand where the patient is, we can’t really help them.”
“The industry has spent decades following directive orders for disease management,” she said. “With these tools and guidelines, now we’re understanding why.”
As case managers reassess patients, Lattimer said, “We can improve health education and communication in a more appropriate manner,” which in turn drives compliance and patient well-being and thereby decreases healthcare costs.
Cynthia Burghard, Gartner research director, said disease management companies have greater ability to manage patients with multiple chronic illnesses.
However, the traditional applications are prohibitively expensive for smaller payers and disease management company nurses, and their patients’ physicians experience fragmentation in workflow and information sharing.
Burghard said smaller plans like Hudson enjoy more control with internally managed disease management programs. “Smaller plans can really design programs that provide a holistic view of what’s happening to their members,” she said.