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Home†>†Disease Management
Medicare/Medicaid Disease Management Set -- The Medicaid Population: Making a Difference with Disease Management & Medicare Disease Management: Tactics to Improve Health, Education and Independence in an Aging Population
Medicare/Medicaid Disease Management Set -- The Medicaid Population: Making a Difference with Disease Management & Medicare Disease Management: Tactics to Improve Health, Education and Independence in an Aging Population
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Tenth in the Disease Management Dimensions Series-Save 50% when you order the Disease Management Dimensions Series.

With 60 percent of adult Medicaid enrollees afflicted with a chronic or disabling condition (most commonly diabetes, hypertension, asthma, psychoses and chronic depression), and nearly half this group suffering from a second condition, this population is in critical need of a healthy dose of disease management (DM), healthcare industry experts say. The number of DM programs serving Medicaid populations continues to rise as states look to these programs to control Medicaid cost increases.

In this special report, "The Medicaid Population: Making a Difference with Disease Management," based on a recent audio conference, expert speakers delve into Medicaid concerns ranging from eligibility and patient engagement to marketing strategies and provider connections as they explain how DM programs can integrate and improve care for those in need.

You'll hear from Jerry Kiplinger, executive director, APS Healthcare and Herb Schultz, vice president, government account management, McKesson Health Solutions, on how to serve the unique needs of the Medicaid population in disease management programs.

This 46-page report is based on the January 25, 2006 audio conference "Serving the Needs of the Medicaid Population in Disease Management Programs" during which Kiplinger and Schultz provided an inside look at their organizations' Medicaid disease management programs.

You'll get details on:

  • Addressing the challenges of patient enrollment;
  • Identifying eligible beneficiaries;
  • Working with public health entities;
  • Maximizing existing resources; and
  • Promoting patient engagement.

Table of Contents

  • Case Study: APS Healthcare Advocates Total Health Management
    • A Multi-Faceted Approach
    • Care Coordination and Staff Support
    • A Patient-Centered Program
    • Overcoming the Obstacles
    • Creating a Workable System
    • Influence of Politics
    • Characteristics of the Medicaid Population
    • Optimizing Community Outlets
  • Case Study: Disease Management Making a Difference at McKesson Health Solutions
    • The Foundation for Effective Programs
    • Maximizing Existing Resources
    • Medicaid Models in the States
    • Serving DM Needs of Medicaid Populations
    • Interruptions in Medicaid Eligibility
    • Clinical Indicators in DM Cases
    • Trends, Outcomes and Solutions
  • Q&A: Ask the Experts
    • Expediting the Process
    • More Members Log On
    • Determining Eligibility
    • Medical Homes Promote Continuity of Care
    • Strategies for Patient Engagement
    • Developing the Care Plan
    • The Coach-Client Relationship
    • Producing and Distributing Provider Toolkits
    • Seeking Out Specialists
    • Setting Some Standards
    • Keeping a Consistent Program
    • The Reality of Internet Use
    • The Low-Down on Physician Engagement
    • Targeting the Aged Population
    • The Technical Side
    • Staff Ratios by Program
    • Marketing Expenses
    • Using the Nurse Advice Line
    • Expanding Treatment to Children
    • Continuing Medical Education
    • Assessing ROI
    • Population Parameters
    • Choosing a Provider Champion
    • Provider-to-Population Ratios
    • Assessing Program Progress
  • Glossary
  • For More Information
  • About the Authors

Twelfth in the Disease Management Dimensions Series-Save 50% when you order the Disease Management Dimensions Series.

A leading cause of illness, disability and death among healthcare consumers, chronic disease claims a disproportionate share of costs for the elderly and generates a heavy financial burden on the nation as a whole. Now more than ever, health plans and providers are seeking strategies to balance the healthcare equation. Medicare disease management (DM) programs have emerged to even the odds, and have already demonstrated positive impacts on patientsí health status and spending.

This special report, "Medicare Disease Management: Tactics to Improve Health, Education and Independence in an Aging Population," highlights challenges and opportunities in working with the Medicare population, strategies to close gaps in care, and steps for sustaining system change and improved outcomes within senior care communities.

Report contributors Blake Andersen, president, Chronic Care Group, Health Sciences Institute, Pamela Fromelt, vice president of government programs, LifeMasters Inc. and Dr. Randall Krakauer, national medical director, retiree markets, Aetna, provide inside details on how disease management programs can serve the needs of Medicare beneficiaries with chronic conditions to improve their health status, while reducing spending on these conditions.

This 41-page report is based on a spring 2006 audio conference, "Medicare Disease Management: Identifying and Engaging the Elderly Population To Improve Chronic Health Status."

Table of Contents

  • Analysis: Demography, Geography and Risk
    • Bridging Gaps Across Care Settings
    • The Real Question: Does It Work?
    • Barriers to Quality Improvement
    • Applying Lessons Learned
  • Case Study: LifeMasters Braces for Aging Baby Boomer Impact on Health System
    • Inside LifeMastersí Medicare Programs
    • A Laundry List of Challenges
    • Advantages of Working with the Medicare Population
    • Key Strategies for Success
  • Case Study: Aetna Identifies Disparities in Senior Care
    • A Model for Development
    • Characteristics of the Medicare Population
    • Creating an Inclusive Program
    • An In-Depth Look at Medicare Health Support
    • Staff Ratios for Medicare Populations
    • Early Results Pave Road to the Future
  • Q&A: Ask the Experts
    • Identifying Risk in the Medicare Population
    • Predictive Modeling Techniques
    • Strategies for Enrollment and Engagement
    • The Cost of Medicare DM
    • Assessment Tools & Techniques
    • Meeting Consumer Demand
  • Glossary
  • For More Information
  • About the Authors
Publication Date: April 2006
Number of Pages: 87
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2019 Healthcare Benchmarks: Reducing Avoidable Healthcare Utilization

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