Background
A common goal: access to affordable, quality health care. Challenges: care “fragmented” across different systems and providers; slow adoption of proven (“evidence-based”) medicine; inadequate support of consumer decision-making
Solutions to Address These Challenges
Connecting individuals
with programs to manage chronic
conditions Connecting individuals
with health & wellness
programs Connecting individuals
with quality care Healthy With Risk Factors Asymptomatic Disease Acute Illness major Acute Illness minor Healthy
Illness/
· Referral by member, clinician, or through Care Management assessment
o Self-assessment through health risk assessment or member call; condition-specific assessment including assessment of level of risk/care needed (23 high risk conditions)
· Identify and resolve issues and care “gaps” (examples: coordinate medications/care; caregiver issues, education needs, community resources)
· Pharmacy benefit structure includes diabetic supplies/insulins in Tier 1
· Work with employers to share/use health and wellness resources with members
Benefit to
employers and individuals
· Provides “safety net” by early identification of those who need early intervention
· Improve individuals’ quality of life; educate them about their condition, treatment and self-care; support behavior changes
· Prevent or reduce hospital admissions, ER visits and/or ineffective care; decrease health care cost trend
Contact for more
information
Jacqueline E. Stiff,
MD, Medical Director, 303-267-3225
Jeanine Ertel, MPH,
Quality Manager, 303-267-3519
Larry Adams, Sales Account Executive, 505-449-4220