Mary Gardner, RN, MA, CCM, CDE

1
Member Management Using TheMed-eXpert System and
Med-eMonitor Patient Appliance

• Mary Gardner, RN, MA, CCM, CDE
• Program Manager, High Risk Diabetes and COPD
• XLHealth

2
Objectives

• To provide information on the previous use and
  implementation of the Med-eXpert System, which
  links together patients using the Med eMonitor
  Patient Appliance, the ADT call center, and
  XLHealth Care Managers

3
The Med-eXpert System
Patient Appliance
Med-eMonitor
Patients
Care Givers
Med-eXpert Information Repository
ADT Monitoring Center
XLHealth Care Manager
4
Target Population

• Diabetes Members with Heart Failure
• Voluntary agreement
• Provider contact approval

5
Med eXpert System

• What Can It Do?
• Patients Med-eMonitor linked to Med-eXpert
  database, appliance sounds an alarm at the time
  of medication dosage or care plan activity
  (answer health query, self-care check, clinic
  visit)
• Records when the member takes their medications -
  it then sends the information to a secure site
  where a Care Manager will review it
• Sends automated alerts if the member is not
  taking their medications properly, experiences
  any side effects, or the responses indicate a
  potential health risk
• Information is confirmed with member and
  appropriate action is taken to facilitate
  medication adherence

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Med-eXpert Care Plan Guidelines

• Medication - Guidelines
• Daily
• Reminder(s) to take medicines
• Confirm adherence or non-adherence
• Solicit reasons for non-adherence
• Monthly
• Contact to determine if have had
• Any medication changes

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Med-eXpert Care Plan Guidelines (contd)

• Intervention - Guidelines
• Weekly
• Reminder to test glucose, and enter
  levels into Med-eMonitor appliance
• Reminder to follow healthy meal plan
• Reminder to inspect feet and wear protective
  footwear
• Monthly
• Contact to determine if have had
• Any ER visits this month
• Any hospitalization this month

8
Medication AdherenceCare Plan - Goals

• Long-Term Goal
• Member will take medications as prescribed by
  their provider to improve health outcomes and
  reduce health care costs
• Short-Term Goal
• Member will adhere to their daily
• medication regimen as prescribed
• by their provider

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Medication/Care Plan Adherence Care Manager
Interventions

• The Med-eXpert System enables Care Manager
  evaluation of factors affecting Medication and
  Care Plan Adherence
• Medication adherence (e.g. side effects, out of
  meds, etc.)
• Financial issues
• Poor memory
• Complex dosing regimen
• Lack of understanding of therapeutic benefit
• Barriers to diabetes self-care
• Emotional issues
• Evaluates home support system
• Refer to appropriate resources to maintain safe
  medication administration
• Maintains provider collaboration
• Evaluates need for Social Services referral

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Diabetes Care Plan - Goals

• Long-Term Goal
• Member will follow Diabetes care regimen
• prescribed by their provider
• Short-Term Goal
• Member visits provider and specialty providers
  regularly
• Member verbalizes understanding of blood glucose
  targets
• Member knows the importance of following an
  individualized healthy meal plan
• Member practices healthy foot care

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Diabetes Care PlanCare Manager Interventions

• Contacts provider for SBGM frequency, if unknown
• Contacts provider for referral to
• Dietitian
• Diabetes Educator
• Social Services
• Specialty Providers
• Endocrinologist, Wound Care Center, Podiatrist,
  Pedorthist, Vascular Specialist, Opthamologist
• Educate members to call their provider for
• Significant changes in blood glucose results
• Episodes of hyper-or hypoglycemia symptoms

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Foot Exam Care Plan - Goals

• Long-Term Goal
• Will perform daily foot exam
• Will wear diabetic shoes and inserts daily
• Podiatrist evaluation is complete and will seek a
  routine podiatry evaluation at least annually/
  4 times/year
• Verbalizes importance of emergent podiatrist appt
  if rest pain occurs
• Short-Term Goal
• Verbalizes importance of seeking evaluation
• within 48 hours of observing foot problem
• Will perform daily foot exam

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Foot Exam Care Plan Care Manager Interventions

• Assist member to
• Find a Primary Care Physician, if needed
• Find a Podiatrist, if needed
• Find a Pedorthist, if needed
• Find an LEX vascular surgeon, if needed

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ER Visits and Admissions

• To evaluate
• Member care needs
• Regular provider and specialty visits, DME
• Healthcare compliance
• Medication regimen, self glucose monitoring,
  healthy meal plan, healthy foot care
• Knowledge deficits
• To facilitate Care Manager interventions
• To Avoid Hospitalizations and ER Visits!!

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Thank You!Questions?
Mary Gardner, RN, MA, CCM, CDE Program Manager,
High Risk Diabetes and COPD XLHealth