State of Texas and Higher Education
Employees, Retirees and their Dependents
Disease Management
The following are Disease Management Programs offered at no charge by the Scott & White Health Plan to Texas Employees Group Benefits Program.
| Asthma Secondary Preventative Coronary Artery Disease Diabetes and Congestive Heart Failure |
Asthma: The Scott & White Health Plan (SWHP) has begun an Asthma initiative as part of its chronic disease management program. A Multi-disciplinary team consisting of physicians, administrative staff, nurses, and medical information systems personnel was assembled to monitor and enhance the program.
The objectives are to improve coordination of care for asthma patients and enhance quality of life by encouraging and empowering members with asthma to participate in managing their own health through provision of pertinent information, tools, training and care management support. It was determined that an opportunity existed to decrease emergency room utilization, clinic/hospital utilization, and drug utilization (with a byproduct being decreased cost of care) while improving the quality of life for SWHP asthmatic members and increasing physician satisfaction in the system's monitoring and treatment process.
Secondary Preventative Coronary Artery Disease: Scott & White Health Plan found that chest pain and unstable angina rank as the #1 and #4 inpatient diagnoses in the over 65 age group, ischemic heart disease ranks #5 in the outpatient diagnoses, and chest pain ranks #1 in emergency room diagnoses (more than doubled in 2000 over 1999). The SWHP Secondary Prevention of Cardiovascular Disease Team addresses these high volume diagnoses.
Two Months After Event:
- Letter mailed to all members who have had a cardiac event with recommendations for "heart healthy living".
- These members can return a postage paid postcard to receive additional educational material.
- The primary care physician (PCP) is mailed a list of their SWHP members who have had a cardiac event to facilitate timely follow-up.
- The comprehensive list of SWHP members who have had an event is e-mailed to those administrative staff who are able to facilitate a follow-up appointment and lab work.
Four Months After Event:
- Primary Care Physicians are mailed a reminder memorandum for all SWHP members on their panel who have not had a cholesterol level taken by four months after cardiac event.
- A letter is mailed to the member suggesting they contact their PCP for follow-up and possible lab work.
Yearly And As needed:
- The Coronary Artery Disease Team meets yearly after the guideline has been measured by chart review. Based on results of the measures, the Secondary Prevention of Coronary Artery Disease Team may choose to focus on a different aspect of the guideline, initiating new program features, as the team deems necessary.
- As new scientific evidence indicates a need for change, the guideline is reviewed and revised to serve as a reference for all S&W and contracted network physicians.
Diabetes and Congestive Heart Failure: Four clinics are staffed with two Chronic Disease Management (CDM) Nurses who work with Scott and White Health Plan adult members with the diagnosis of Diabetes or Congestive Heart Failure (CHF).
A multi-disciplinary team, chaired by a Family Medicine physician, meets quarterly and reviews team activities and reports. An Endocrinologist chairs a team that meets every six months to review the clinical data and recommend interventions including an annual mail out of educational materials to members with Diabetes. CDM Nurses are provided with a list of members admitted as an inpatient or treated in the emergency room with the diagnosis of CHF submitted on the claim form as one of the top 3 diagnoses. Analysis of program performance data for the last two years, was completed by a SWHP financial actuary. An updated brochure is used to provide information to health care practitioners about the program. CHF Algorithm was created and approved by the CDM Team. New members eligible for the program are identified quarterly using claims data.
Please contact your PCP for enrollment or more information regarding these Disease Management Programs.
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