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CVC Member and Physician Interventions

The physician and patient can collaborate together, to take proactive steps toward addressing and managing Cardiovascular Conditions (CVC).

Interventions Based on Risk Stratification

The HealthPlus Risk Stratification method is based on condition eligibility criteria, clinical and financial data, predictive modeling, and self-reported information. Stratification is a dynamic process, and the stratification level can change as the member’s condition changes.

Eligible members are categorized into four levels of risk, where Intense represents the highest level of risk and Low indicates the lowest level of risk.

Member Interventions

The CVC patient may be provided the following interventions to address CVC issues. 

Intervention

Risk Level



Low

Moderate

High

Intense

Introductory letter and program packet informing how member was identified, how to use the services and how to opt out

Once initially

Once initially

Once initially

Once initially

Welcome call

Once initially

Once initially

Once initially

Once initially

Health Appraisal (includes depression screen)

Every two years

Every two years

Every two years

Every two years

Disease-specific newsletter (includes lifestyle issues, smoking cessation, etc.).

Periodically

Periodically

Periodically

Periodically

Educational materials

4-6x /year

4-6x /year

4-6x /year

4-6x /year

Special equipment (blood pressure cuff)

As needed

As needed

As needed

As needed

Web-based support and education (Krames Online /disease-specific videos)

Available

Available

Available

Available

Seminars (e.g., nutrition)

2x /year

2x /year

2x /year

2x /year

Tobacco cessation

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Weight management

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Behavioral health referral

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Member satisfaction survey

Annually

Annually

Annually

Annually

General standards of care reminder message (automated phone/mail)

Annually

Annually

Annually

Annually

Missed services reminders
(automated phone/mail)

3x/year

3x/year

3x/year

3x/year

Polypharmacy review

Monthly

Monthly

Monthly

Monthly

Care Counseling RN monitoring and assessment calls (includes SOC & PHQ2)

 

 

Monthly

 

Case Management Telephone assessment for standards of care compliance

 

 

 

Monthly

Case Management discharge Telephone assessment for standards of care compliance after inpatient admission for CVC

 

 

 

Each Discharge

Enrollment for disease management/case management (post hospitalization)

 

 

 

Each Discharge

Practitioner Support

The medical practitioner may be provided the following interventions to address CVC issues.

Intervention

Frequency

Program fax-back form to get provider input on High stratification members and the appropriateness for monthly RN care counseling calls

At least annually

Provider manual introduction to programs

Updated annually

Notification of Disease Management Program information in ProviderPlus newsletter

Annually

Educational tools for offices (e.g., CVC flow sheets, laminated educational tools)

As needed

Cardiovascular Action Report (member exception reports)

At least 3x/year

Patient Chronic Care Profile identifying potential missed services and co-morbid conditions

Semi-annually

HEDIS compliance reports with academic detailing (with benchmark and peer comparative analysis) to PCPs

At least annually

Lunch and Learn by RN disease management coordinators

Offered

Pharmacist review of medical/pharmacy utilization for members (meeting the polypharmacy program criteria) includes provider education and therapy optimization recommendations

Monthly

Nurse review of records for individualized performance feedback and education for physicians with members in Moderate-High-Intensive risk stratification

As needed

Office staff educational forums provided by HealthPlus

At least annually

Office Care Improvement

  • Audit, feedback
  • Tools, materials
  • Physician and office staff education related to CVC
 

As needed

HealthPlus.org Web-based support, including access to many patient education tools, clinical guidelines and forms to promote electronic exchange of information (provider can request mail option)

Ongoing

Physician/Provider satisfaction survey

Annually

Tobacco cessation program materials

Telephone / Fax Referral / Website

Depression screening materials

Print Tools/Website

Weight management program

Telephone / Fax Referral / Print Materials / Website

Web-based KRAMES Online patient education materials and disease specific videos

Available as needed

Explanation of Member and Physician Interventions

The following services are available to all eligible member Cardiovascular Conditions patients:

  1. Introductory Welcome Packet, containing:
    • Welcome letter
    • Toll-free telephone number to HealthPlus and Disease Management Department email address
    • Program opt-out information
    • Information on how to access  cardiovascular condition (CVC) information on the HealthPlus web site
    • CVC-specific standards of care and sick day plan,
    • CVC-specific personal health workbook
     
  2. The member’s primary care and/or treating physician receives the following information regarding the CVC Disease Management Program through the HealthPlus Provider Manual, provider newsletter, and HealthPlus web site:
    • Information on how to use the Disease Management Program
    • How the Disease Management Program works for patients
    • Toll-free telephone number to HealthPlus and Disease Management Department email address
    • Information on how to access cardiac information on the HealthPlus web site
    • CVC-specific Clinical Practice Guidelines
    • Physician Annual Report demonstrating individual PCP performance rates for the HEDIS® Persistence of Beta Blocker Therapy, Controlling High Blood Pressure, and Cholesterol Management for Patients with Cardiovascular Conditions measures
    • Physician Reports on potentially non-compliant members refilling prescribed beta blocker medication as needed (PRN)
     
  3. Post- Acute Myocardial Infarction (AMI) self-care materials are mailed to members discharged post-AMI, providing educational materials on beta blocker, aspirin medication, and smoking cessation, and encouraging commitment to a Take  Action Against Heart Disease contract which encourages the member to monitor blood pressure, manage cholesterol levels, manage weight, quit smoking, exercise, and manage stress.
  4. Primary Care Physicians (PCP) are notified by fax that a patient has been discharged with an AMI diagnosis.
  5. Reminder mailings to members three months and six months after AMI to encourage them to remain on beta blocker medication, unless discontinued by their physician due to a contraindication.
  6. CVC-related standard of care service reminders are provided annually to adult members. These reminders urge patients to talk with their doctor about how to manage their disease and medications and how to follow a treatment plan. The reminders specifically address when to obtain a fasting blood sugar test, cholesterol test, flu shot, and medication review.
  7. Automated telephone reminders are sent to members whose claims history suggests they are missing services (fasting blood sugar, LDL cholesterol test, flu shot, and blood pressure check).
  8. Coordination with tobacco cessation, weight management, and depression screening services.
  9. Members of the HealthPlus CVC Disease Management Program who are discharged from a hospital with a diagnosis of CVC are evaluated for HealthPlus Case Management services. The case management assessment process includes a thorough evaluation of the patient’s medical conditions and psychosocial issues. The case management program provides ongoing management of the patient’s conditions.
  10.  Chronic Care Profiles – Member-specific Chronic Care Reports  provided to the primary care physician (PCP) detailing recent CVC disease-related services, ER visits, inpatient admissions, and claims-based documentation of co-morbid conditions (end stage renal disease and hypertension). The report provides an analysis of potential non-compliance with medication plans and status of pharmacotherapy management from pharmacy claims. In addition, dates and results (if known) of the last service for standards of care, vaccination status, and BMI are identified.
  11.  With the permission of primary care physicians, CVC missed services reminder letters are mailed under the PCP’s name to members who have been identified as not meeting heart failure standards of care for fasting blood sugar, LDL-C, flu shot, and medication review. The letters encourage members to contact their PCP for services.
  12.  The Polypharmacy Program coordinates the activities of Disease Management Coordinators, Pharmacy Department, and HealthPlus practitioners and providers to assess use, compliance, and adherence to member pharmacotherapy management. Members are contacted via telephone or mail regarding education and importance of pharmacotherapy compliance. Members’ contraindications are noted in the Computerized Maintenance Management System (CMMS) record.
  13.   Physician Reports are sent periodically and include a list of members with a CVC diagnosis without an annual fasting LDL-lipid profile result.
  14.  HealthPlus benefits allow members to obtain supplies and special equipment through participating durable medical equipment (DME) providers or pharmacies. CVC members may be assessed for home monitoring of blood pressure.  Members are encouraged to monitor blood pressure at home and discuss results with their provider.
  15.  Health and Lifestyle seminars are held periodically in Flint and Saginaw locations.
  16.  The Diabetes/Cardiac/Heart Failurenewsletter is mailed periodically to members and contains useful information for self-management of cardiovascular conditions.
  17.   Member satisfaction surveys are mailed annually to a sample of the HealthPlus CVC patient population to measure satisfaction with the HealthQuest Disease Management Program, absenteeism, and the patient’s perception of health status.
  18.   Physician Surveys are mailed annually to physicians to measure satisfaction with the HealthQuest Disease Management Program.
  19.  The HealthPlus website provides valuable information about disease management, including educational materials and links for physicians, adults, teens, and children, some of which are available in Spanish. Cardiac-specific educational videos are available on the website for members to view.

Measures of Effectiveness

HealthPlus employs and tracks performance measures for each Disease Management program. Each measurement:

  • Addresses a relevant process or outcome
  • Produces a quantitative result
  • Is population based
  • Uses data and methodology that are valid for the process or outcome measured
  • Has been analyzed in comparison to a benchmark or goal

HEDIS®

Current measures include the following:

  • Control of high blood pressure
  • Persistence of beta blocker treatment after a heart attack
  • Cholesterol Management for patients with cardiovascular conditions
  • The percentage of members who are currently taking aspirin, including:
    • Women 56-79 years of age with at least two risk factors for cardiovascular disease
    • Men 46-65 years of age with at least one risk factor for cardiovascular disease
    • Men 66-79 years of age, regardless of risk factors
     
  • The percentage of members who discussed the risks and benefits of using aspirin with a doctor or health care provider, including:
    • Women 56-79 years of age
    • Men 46-79 years of age
     

Additional Measures/Outcomes

HealthPlus uses various methods to measure the following components of patient care:

  • Member satisfaction:  HealthPlus annually evaluates satisfaction by evaluating member survey results and member inquiries and complaints.
  • Physician satisfaction:  HealthPlus annually evaluates satisfaction by evaluating physician survey results.
  • Health care cost reduction
  • Health care utilization (in-patient, emergency department, pharmacy)
  • Annual member participation rates

For more information about the HealthPlus Cardiovascular Conditions Disease Management Program, please contact a HealthPlus Disease Management Coordinator at (800) 345-9956, ext. 8050, or by e-mail to dismgmt@healthplus.org.

Additional Resources: