Physician Driven Disease Management

Program Scope and Objectives:

It is our philosophy that optimal disease management is provided by physicians. Using nationally published guidelines from the respective specialty colleges, the PIC program utilizes the latest evidence-based medicine approaches to disease prevention and treatment. Communication between the physician and the patient is key; using the claims and enrollment data, PIC provides a clinically reliable conduit – helping the practicing physician learn what patients are in need, as well as providing assistance in the education and motivation of those at risk patients to seek the appropriate treatment. PIC’s monthly peer review process establishes a culture of constant improvement in the identification and treatment of those patients at risk.

Performance Measurement and Reporting

Data and information are requisite for physicians to manage their patients appropriately; PIC alone has established the relationships with practicing physicians that allow for the interactive sharing of clinical information on patient health status. Traditional Health plans have difficulty collecting and disseminating actionable data to the treating physicians and many times resort to funding duplicative services to attempt to enhance patient compliance. PIC has pioneered effectively working directly with physicians and distributes clinical information, not just data, directly to the physician who is coordinating and managing the patient. PIC has also developed a performance based incentive package with annual distributions going to the member physicians in amounts significant enough to receive the appropriate level of attention to these additional care coordination activities. Partners In Care’s approach is unique and successful because the process has been developed and is owned by practicing physicians seeking to change the culture of healthcare and reinstate their ability to manage their patient’s care directly with their patients.

Over the years PIC has developed a data warehouse consolidating information and data from healthplans, third party administrators, and utilization/case managers. Predictive modeling algorithms are used to target those patients predisposed to chronic diseases. The health condition of each plan participant is assessed particularly targeting those where more than one chronic condition may be present. PIC’s Medical Directors (all practicing physicians) review each case to determine interventions best suited to the participant. Interventions are discussed with the primary treating physicians and participant to assure optimal medical care and care plan development.

Annual review is inadequate to ensure continued quality improvement and better health for program members. The aggressive management of information and outreach to the member’s physician, coupled with our physician leadership’s clinical expertise has resulted in successful outcomes and healthier members.

Partners In Care has adopted the American Healthways Standard Outcome Metrics and Evaluation Methodology for it’s Disease Management Program. This serves as the basis for the evaluation of outcome metrics for disease management. Information collection begins immediately with Health Risk Assessments (HRA) being provided to each Plan Participant. The completed HRAs are secured in our protected database allowing the medical director to review and assess each one upon receipt.

Our physician-driven disease management program for participants consists of the following components:

o Early prenatal education and intervention to reduce the severity and incidence of pre-term births and other pregnancy-related complications.

Partners In Care is able to provide these Disease Management services as a stand alone program or as a natural adjunct to the Health Plan Improvement Program.

Customized rate proposals and incentive arrangements are available upon request.