Assisting Members with Multiple Chronic Conditions

1
Assisting Members withMultiple Chronic Conditions

• ACHP Web Conference Series
• Karen Kraemer, RN, CMC, Sr. Director
• July 27, 2004

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A View of HealthPartners

• Health Medical Management Programs
• Our chronic care strategy
• Stratification Guidelines for Co-Management
• Our decision tree for the complex milieu
• Operational Tools, Processes, Systems, Etc.
• Our daily work in the real world
• Simplifying Things for Members
• Our communication with the customer

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AchieveSM Health Improvement Programs Level One
CareSpanSM Health and Medical Management Programs
Focusing on engaging members in health improvement
CareSpan Level 2 Disease Prevention
and High Risk Pre-Disease
Management Finding and engaging the high risk
group who are at risk for new disease in the next
2-3 years
CareSpan Level 3 Condition and
Disease Management Focusing on members who
need care now
CareSpan Level 4 Complex Case
Management Engaging those who will need care in
the next 12 18 months. Focusing on members
with complex, high cost diseases conditions
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Stratification Guidelines

• Level 4 Case Management
• Medical gt Behavioral Health
• Clinical assessment unique needs of the patient
  determine the level of services used
• Coordination of services from within Levels 1-4
  
• Level 3 Disease Management
• Rare Chronic gt ESRD gt
• COPD gt CHF gt CAD gt Diabetes gt Asthma
• Interventions per diagnosis and severity
• Coordination of services from within Levels 1-3

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Operational Checks and Balances
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Helping Our Members

• Call into Member Services
• CareSpan program letters
• CareSpan program brochures
• HP member newsletter
• Open enrollment brochure
• New member packet
• Web site information

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We keep working on

• Communication
• Focusing on patients
• Communication
• Keeping it simple
• Communication
• Focusing on patients
• Communication
• Keeping it simple

• Communication
• Workflows
• Communication
• Tools
• Communication
• Systems
• Communication
• Training