Today’s IT has made many advancements possible in the health care industry. Employers should look for a carrier that utilizes these advances in the field of population care management (PCM).
“The main function of the PCM department is to do outreach to members in need of certain health care interventions,” says Dr. Mark A. Roth, a physician adviser for the population care department of Kaiser Permanente.
By using health IT to augment PCM, physicians can improve preventive care as well as how chronic diseases are treated.
Smart Business spoke with Roth about how technology has improved PCM, and how PCM can help employers reduce health care-related expenses like absenteeism.
How does PCM impact preventive care?
One way is reaching out and contacting people in need of preventive care screenings, like mammograms, Pap tests or testing for colon cancer. Through the use of state-of-the-art computer tracking and monitoring programs, the PCM team is able to identify members who are overdue for preventive screenings.
The criteria used to identify these members are based on national evidence-based guidelines that tell us certain age ranges of people who need to have these screenings done for cancer prevention or early detection of cancer. Our electronic programs allow us to quickly identify which people in a given age range have not had the tests done in the specified timeframe.
The PCM team is then able to provide outreach to patients who are overdue for tests. The outreach can occur in the form of a letter or a phone call. For example, a letter is mailed to the member’s home to alert her that she is overdue for a test and would offer a phone number for her to call for assistance with scheduling an appointment. In some cases the overdue member may receive a phone call. Sometimes the calls are made by live callers, and sometimes they are made via interactive voice response, in which a computer-generated call is made to the individual who needs one of these tests done.
How can PCM help control chronic diseases?
The main chronic conditions PCM deals with are diabetes and cardiovascular disease. The PCM department is comprised of four registered nurses, several licensed practical nurses, data analysts and support staff who focus on identifying and managing the care of members with high-risk indicators. One high-risk indicator they look for is chronic, very high blood sugar ratings. They can identify that through computerized registries. It’s basically the same computer platform used for preventive care screenings.
The nurse does a chart review to identify the issues that are contributing to poor control of the patient’s blood sugar. After that chart review, the nurse has a conference call with the patient’s primary care physician. The two of them devise a care plan for how best to address the uncontrolled nature of that person’s conditions.
As a rule, nurses are very good at explaining things to patients in more understandable language than physicians. Nurses use these phone calls to really try to get to know patients, work through their issues, and understand the lifestyle stresses that make it hard for them to fully comply with their care plan.
