| |
CenCal Health strives to enhance the scope of health care and services provided by our network of primary care physicians and specialists. Disease Management Programs are developed to provide education and targeted interventions to members with certain high-risk diseases.
CenCal Health identifies members with certain chronic conditions, and develops and implements network-based Disease Management Programs to address their health care needs. These programs work with primary care physicians and specialists to improve clinical outcomes, reduce or delay long-term complications, and manage the member's care in a cost-effective manner.
CenCal Health's Disease Management Programs include the Diabetes SMART Program (Successful Management Always Requires a Team), the Asthma SMART Program, and the Comprehensive Perinatal Health Management Program.
Diabetes SMART Program (El Programa Diabetes SMART)
- Mission Statement: To promote the provision of outcome focused, multidisciplinary, and culturally relevant, diabetes services to
CenCal Health's members.
- Program Components:
- Primary Care Physician managed diabetes care
- Diabetes self-management education to all diabetic members
- Local specialists and endocrinology referrals
- Coordination of community resources for diabetes education and support
- Dilated eye exams or retinal photographs to check for diabetic eye disease
- Laboratory analysis including HbA1c, microalbuminuria, lipids including LDL
- Regular foot exams with podiatry referrals
- Blood pressure and weight at each physician visit
- Member Outcome Goals: *
- HbA1c < 7.0%
- LDL cholesterol < 100 mg/dl adults < 110 mg/dl for children with risk factors in addition to diabetes
- HDL > 35 mg/dl males, > 45 mg/dl females
- Triglyceride levels < 200 mg/dl
Automatic Enrollment: All diabetic members are automatically enrolled in the Diabetes SMART program. New diabetic members or those needing additional support or assistance in obtaining services may contact
the Health Services Department at extension 1640.
Better Beginnings Program
- Mission Statement: To promote the provision of timely prenatal and postpartum care, and promote healthy pregnancies and birth outcomes through education and services for health plan members and providers.
- Program Components:
- Pregnancy information packets mailed in English and Spanish to pregnant health plan members. Information provided includes the importance of prenatal care, signs of preterm labor, what to expect during pregnancy, nutrition, breastfeeding, making healthy choices, smoking cessation and car seat safety.
- Post-partum visit reminders mailed to pregnant members following delivery. Information provided on infant health and safety, smoke free homes, and childhood vaccinations.
- Added benefits for pregnant members, including lactation education, nutrition education, and coverage for childbirth classes.
- Information and referrals to community resources including smoking cessation programs, nutrition assistance (WIC), childbirth education, and lactation assistance.
- Assistance with ensuring transportation to obstetrical medical appointments.
- Referrals to Comprehensive Perinatal Service Program (CPSP) Providers: The CPSP provides comprehensive assessments, pregnancy and childbirth education, nutritional and psychosocial assessments and interventions for social and possible drug or alcohol issues, prenatal vitamins and minerals, individual care plans, and referrals to community resources.
CenCal Health promotes referrals to CPSP or CPSP like services and seeks to increase member and provider participation in these programs.
- Goals (based on HEDIS quality measures)
- Initiation of prenatal care within the first 13 weeks of pregnancy or within 6 weeks after receiving SBHI eligibility.
- Receipt of a postpartum care visit within 4 to 6 weeks after delivery.
- Long-term program specific process goals:
- Increase to 90% the proportion of women receiving prenatal care in the first trimester.
- Increase to 80% the proportion of women receiving postpartum visits within 4-6 weeks after delivery.
- For Better Beginnings program information and materials:
- Contact: Suzanne Michaud, MPH, Senior Health
Promotion Educator at 1-800-421-2560 x 1662
Asthma SMART Program
- Mission Statement: To promote the provision of outcome focused, multidisciplinary, and culturally relevant, asthma services to
CenCal Health's members.
- Program Components:
- Primary Care Physician managed asthma care
- Asthma self-management education to high-risk members with asthma
- Local specialist referrals
- Coordination of community resources for asthma education and support
- Asthma Action Plan for all members with persistent asthma
- Collaboration with Primary Care Physicians by means of medication usage reports to assist coordination of care
- Member Outcome Goals:
- Continuous inhaled corticosteroid therapy for members with persistent asthma > 8 canisters per year. ***
- Asthma control and improved quality of life as measured by reduced use of short acting beta agonist inhalers < 8 canisters per year.
Automatic Enrollment: All members with asthma are automatically enrolled in the Asthma SMART program. New members with asthma or those newly diagnosed or needing additional support or assistance in obtaining services may contact
the Health Services Department at extension 1640.
*Based on the American Diabetes Association Clinical Practice Recommendations 2000
**Based on American College of Obstetrician and Gynecologist (ACOG) "Guidelines for Perinatal Care, Fourth Edition" (approved by
CenCal Health's Quality Assessment and Improvement Committee, March 16, 1999); CPSP Medi-Cal benefit, Title 22, California Code of Regulations, Sections 51348, and the MMCD Letter No. 96-01, February 7, 1996. Complete copies of these standards are kept on file in the Health Services Department of
CenCal Health for member or provider review.
***Based on the National Heart, Lung and Blood institute, Guidelines for the Diagnosis and Treatment of Asthma
|
|
