Keys to Caring For Dual Eligibles

Key to caring for dual eligibles, who constitute about 9 million individuals in the United States, is, among other things, designing a care management plan that identifies local needs, says Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. The not-for-profit California-based health plan has developed a multi-pronged, member-specific approach to reaching dual eligibles that has earned kudos from the healthcare industry.

Critical here in this population is the home part — developing a model so that you know what’s happening in the home. The social and home environment impacts everything: it impacts the compliance on medications and the medical advice of the physician. It deals with nutrition, and transportation issues; if the person lives in an area where they have no access to transportation, you’ll have to be able to provide that.

You also need to coordinate with the medical liaisons, developing an early warning system for the physician, the primary care doctor or the specialist. You also need to develop good member buy-in and member satisfaction on your care management program.

How do you make sure it works as you’re developing it? Critical here are the stakeholders, the people in the community that will look at this and evaluate how you do and determine your future. You need to make them buy into the process. Go out and visit with them and bring them into your evaluation. They’re going to be the ones that can give you some early warning signs on how well you’re doing or identify some of the problems you may have. Develop close relationships with community providers, such as the people that do provide the personal care or the nutrition, things like Meals on Wheels, existing programs in the community, the Triple AAA’s.

In summary, we’ve talked a little bit about designing your care management program with the local needs identified. Strong identification and risk stratification programs and engagement of the member, the caregiver and providers are required. I don’t think I can stress enough the importance of overcommunicating to everyone involved. Measure how you’re doing with the goals on the program, and then start all over and look at these things again.

Source: Population Health Management for Dual Eligibles: Blueprint for Care Coordination

Population Health Management for Dual Eligibles: Blueprint for Care Coordination

Population Health Management for Dual Eligibles: Blueprint for Care Coordination details SCAN’s unique care management model for duals, which focuses on prevention and early intervention, particularly in the area of medication management.

This entry was posted in Disease Management, dual eligibles, Elderly Care and tagged , . Bookmark the permalink.
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