Medicare - Chronic Care Improvement Programs |
An Overview
ConnectiCare defines chronic care improvement as a method for identifying a population of members with a specific disease or condition, and helping to manage that population in the context of an integrated, multi-disciplinary approach.
The objectives of the Chronic Care Improvement Programs include: promoting measurable improvement in members’ health status through self-assessment and management of symptoms, promoting physician compliance with nationally recognized treatment guidelines, and ultimately reducing the overall costs associated with chronic disease.
ConnectiCare members with chronic obstructive pulmonary disease, diabetes, heart failure or coronary artery disease will receive mailings describing our Chronic Care Improvement Programs and the benefits of participation. Members who are identified at highest risk through medical claims or risk assessment, and choose to participate, will receive regularly scheduled contacts from a nurse case manager, as well as written information on managing their condition.
ConnectiCare Chronic Care Improvement Programs
Programs developed and implemented to date include:
|
Title
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Target Condition
|
Physician Audience
|
Inception Date
|
|
BREATHE
|
Chronic Obstructive Pulmonary Disease
|
Family Practice, Internal Medicine, Pulmonologists
|
2008
|
|
DiabetiCare
|
Diabetes
|
Endocrinologists, Family Practice, Internal Medicine
|
2008
|
|
Heartcare
|
Heart Failure
|
Cardiologists, Family Practice, Internal Medicine
|
2008
|
|
|
Coronary Artery Disease
|
Cardiologists, Family Practice, Internal Medicine
|
2008
|
|
ConnectiCare does not maintain any financial ownership arrangements between itself and any other entity engaged in advertising, marketing, or the provision of goods and services offered through ConnectiCare’s Chronic Care Improvement Programs. In addition, ConnectiCare does not advertise, market, or promote any specific products or services to members or practitioners when discussing a member’s health condition.
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ConnectiCare develops its Chronic Care Improvement Programs in consultation with local physicians. As programs are developed, ConnectiCare distributes program documentation to physicians who, based on their specialty, may have patients who would benefit from these specific programs. These routine program updates may include periodic reports, updated guidelines, or notification of a member’s participation. Any confidential member information received should be filed in the member’s medical record. If you do not want to receive these mailings, please contact our Chronic Care Improvement Programs Department at the number below.
Updates of a more urgent nature may be deemed necessary by the nurse case manager in the event a member's health condition has changed. In this instance, the nurse case manager will attempt to contact the physician by phone.
If you would like to know more about specific program content, visit our Health Management Center. Printed copies of program descriptions, educational materials and mailings to members are available upon request.
To enroll one of your patients in a program or if you have any comments or complaints about a Chronic Care Improvement Program, contact the Medicare Case Management Unit, Monday - Friday, 8 a.m. - 4 p.m., at 1-800-829-0696.
Practitioner Rights
Practitioners who participate in ConnectiCare’s Chronic Care Improvement Programs have the right to:
• have information about ConnectiCare’s programs and services, including the staff, the staff qualifications, and any contractual relationships related to Chronic Care Improvement Programs.
• be informed of how ConnectiCare’s programs coordinate interventions with treatment plans for individual members.
• know how to contact the person responsible for managing and communicating with the practitioner's patients.
• be supported by ConnectiCare’s programs to make decisions interactively with members regarding their health care.
• receive courteous and respectful treatment from ConnectiCare staff.
• communicate complaints to ConnectiCare.
• decline participation in Chronic Care Improvement Programs.
