Samaritan Select Disease Management

1. Samaritan Select Disease Management Chronic Care Support Program

2. Program Overview • Based on Improving Chronic Illness Care (ICIC) - Chronic Care Model & Disease Management Association of America (DMAA) principles • Utilizes: • Interdisciplinary clinical teams • Prevention guidelines • Evidence-based practice guidelines • Self-management goal setting • Case management • Continuous analysis of relevant data and cost-effective technology to improve health outcomes of members with specific diseases

3. Program Design • Members automatically placed in Disease Management program upon identification • “Opt-out” program (Members considered participating unless they request out) • Disease Management program integrated with providers, case management and medication management

4. Specific Diseases • Initial • Diabetes • Asthma • CAD • CHF • Future Considerations • Depression • Hypertension • Hyperlipidemia • Obesity

5. Current Components • Health plan disease database • Evidence-based practice guidelines for specific diseases • Collaborative practice model with interdisciplinary clinical team • Patient self-management education • Process and outcomes measurement, evaluation and management • Routine reporting/feedback loop

6. Interdisciplinary Clinical Team • Member • PCP • Health Plan: • Case Management Nurses, Clinical Pharmacist • Hospital: • Case Management Nurses, Discharge Planners, Diabetic Educators, Respiratory Therapists, Cardiac Rehab • Others as indicated

7. General Disease Management Identification Process

8. Once in the Disease Database • Member placed into a specific level of case management determined by criteria • Members contacted & followed periodically by case management nurses • Care plan completed on each member placed in case management • Case management nurse works closely with provider, member & other members of the interdisciplinary team • Case loads compared periodically with disease database

9. Outcome Measurement and Evaluation • Various types of reports reviewed on an ongoing basis. • HEDIS Measures • Member & Provider surveys • Modifications made as necessary

10. Future Considerations • 24/7 Nurse Triage • Motivational Interviewing • Predictive Modeling • Pay for Performance • Screening Clinics • Regional Disease Registries • Regional Education Program for Patients with Chronic Diseases • Integrated Healthcare Delivery System