HealthWorks 102: Care Management

Welcome to the HealthWorks University course covering care management. Today we’ll cover the concept of care management — what it is, some of the programs being offered and how they might help you.

Slide 2: What Is Care Management?

Care management, sometimes called disease management or condition management, is a term that covers a wide range of programs and services. In general, care management programs are systems of coordinated health care interventions and communications targeted to individuals with conditions — especially chronic ones — that require patient self-care efforts.

Care management programs work to:

support the health care provider/patient relationship and treatment plan

coordinate inpatient, outpatient and ancillary services

emphasize the prevention of complications through adherence to medically-approved guidelines

educate patients on prevention tactics and behavior modification.

The goals of care management are to reduce acute episodes, hospitalizations and variations in care for those with medical conditions. Care management programs are also designed to improve health outcomes and reduce costs.

A variety of care management programs are now offered by many insurance companies, including McClatchy’s insurance provider, Aetna.

Slide 3: Aetna's Care Management Programs

Aetna offers a variety of programs to help participants manage their health. These programs include:

Simple Steps to a Healthier Life health and wellness program

Healthy Outlook Disease Management Program

Moms-to-Babies Maternity Management Program.

Slide 4: Simple Steps to a Healthier Life

Simple Steps to a Healthier Life is an interactive online health and wellness program designed to help participants improve or maintain their health in ways that fit their lifestyles. The program offers step-by-step instructions for achieving specific health goals.

The first step on Aetna’s Simple Steps to a Healthier Life program is to complete an online health risk assessment (HRA). An HRA is an interactive questionnaire designed to help participants determine some of their health needs. If you complete Aetna’s HRA as part of the Simple Steps to a Healthier Life program, you will receive a tailored Health Report and a one-page Health Summary report you can share with your health care provider.

Next you’ll receive a personalized Action Plan with recommendations for Healthy Living Programs based on your individual health needs. These programs offer guidance and support for making positive health changes at your own pace. You’ll have interactive tools and features at your fingertips, such as the Fitness Planner and the Diet Manager. Healthy Living Programs include actions plans for weight loss, stress relief, smoking cessation, healthy aging and more.

The Simple Steps to a Healthier Life program also provides easy-to-find information on diseases, treatments, drugs, tests and medical terms so that participants can make informed health decisions. Information about how to make the most of each doctor’s visit also is available at www.simplestepslife.com.

Slide 5: Healthy Outlook Program

What if you’re already dealing with a chronic condition? There are tools and resources available to help you manage that, too.

Aetna offers the Healthy Outlook Program, an outreach program for members at risk or dealing with chronic conditions such as diabetes, coronary artery disease and congestive heart failure. The program coordinates education, counseling, self-care and physician support for those dealing with chronic conditions.

Aetna identifies members for enrollment in the Healthy Outlook Program in a variety of ways:

Through Aetna’s patient management staff or system

Via the personalized Aetna member Web site, Aetna Navigator

By self-referral or physician referral

Through reviewing medical and pharmacy claims from participants.

Once enrolled, participants may receive condition-specific educational materials, individualized assessments for determining modifiable behavior risk factors and educational needs, intensive educational counseling on topics pertinent to their conditions, follow-up calls, access to case management nurses and self-monitoring equipment.

The Healthy Outlook Program encourages participants to work closely with their physicians in managing their conditions. To this end, disease-specific action plans are shared with participants and their physicians to facilitate appropriate care.

Dealing with a chronic condition can be difficult and sometimes can cause depression. The Healthy Outlook Program recognizes that and offers materials for identifying and managing depression as it relates to chronic illness.

Slide 6: Healthy Outlook: Diabetes

Let’s take a closer look at some of the Healthy Outlook Programs offered by Aetna for participating McClatchy employees.

The Diabetes Program offers outpatient educational counseling on:

Starting an individualized meal plan and physician-directed exercise plan

Monitoring and managing your blood glucose level

Recognizing and managing cardiac risk factors.

The Diabetes Program also offers blood glucose meters (subject to plan coverage) and insulin pumps (when indicated and covered by plan).

Slide 7: Healthy Outlook: Congestive Heart Failure

The Congestive Heart Failure Program offers outpatient educational counseling on:

The role of dietary salt and fluid restriction in managing heart disease

The importance of smoking cessation

Daily vital sign monitoring and communication with your physician

Daily weight measurement and appropriate responses to a weight increase

Compliance with treatment plans, especially medication.

The Congestive Heart Failure Program also offers updates on common medications used in treatment, as well as physician alerts to inform your doctor in case of irregularities in your vital signs.

Slide 8: Coronary Artery Disease

Finally, the Coronary Artery Disease Program involves

A cardiac risk factor assessment

Educational support emphasizing risk factor reduction through lifestyle modification

Comprehensive educational counseling covering: — Weight management — Co-morbid conditions — Smoking cessation — Stress reduction — Cholesterol/lipid monitoring and awareness — Maintaining blood pressure within target range.

Slide 9: Moms-to-Babies Maternity Management

Baby on the way? Helping moms-to-be and their babies have a healthy pregnancy is the goal behind the Moms-to-Babies Maternity Management Program.

As part of the program, moms-to-be receive:

Education on prenatal care, labor, delivery, newborn and baby care, postpartum depression, breastfeeding and specialized information for dad or partner

Web-based materials and access to certain programs through Women’s Health Online

A pregnancy risk survey to help identify potential risk factors and pregnancy complications

Access to a trained nurse who can help manage individual cases with OB care professionals

Postpartum depression screening for high-risk members.

Moms who smoke can participate in the Smoke-Free Moms-to-Be Program that helps them quit smoking and increases the chances of having a healthy baby. The nicotine-free smoking cessation program is managed by obstetrically trained nurses experienced in helping moms-to-be quit smoking.

Slide 10: Health Advocates

Health Advocates are experienced nurses whose role is to assist with Aetna’s care management programs. They act as a health coach and follow up to ensure members understand their treatment plans and are following their doctor’s recommendations. Health Advocates proactively reach out to work with members who are in a disease management program or who have indicated on their health risk assessment surveys that they have a chronic condition that would benefit from this level of support.

Slide 11: Conclusion

This concludes our introduction to care management and the suite of education and support programs offered as part of McClatchy’s benefits. Remember, increasing your awareness about your health and taking the steps needed to control any medical conditions you have can improve the quality of your life.