Posts Tagged ‘geriataric care’

3 Components of Geriatric Health Management for Dual Eligibles

March 27th, 2014 by Cheryl Miller

When designing care management programs for dual eligibles, you need to recognize the strong connection between the medical, the social and the behavioral, explains Timothy C. Schwab, MD, FACP, former chief medical officer of SCAN Health Plan. Ultimately, you are caring for the individual; one person in charge of the whole program.

I’d like to give a broad overview of the care management model that we’ve been using at SCAN. It begins with assessment care planning and care management. But we see it as a continuum — a cross between very traditional medical care management and traditional social care management. We’ve combined it into a centralized spot we call our ‘geriatric health management program.’

We meld all that into one care management program — the medical, the social, the behavioral. And then we utilize expertise from the medical sides; for instance, for a patient with diabetes, we use our diabetic disease management module by that geriatric care manager. Or for behavioral health issues, we use the behavioral health side of the program. But again, it all focuses on the individual; one person in charge of the whole program.

When you design for the dual eligible population, you can divide the population into those that are frail and disabled as a primary type of program, but also recognize that this is a low income population with multiple complex chronic conditions. Coordination is the critical link between the social and the medical. Incorporating the traditional things like disease management, utilization management, transition management and complex care management is essential, since all of these are very critical and interrelated.

Excerpted from Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes.