Connect Archives

July 2007

Sunday, July 01, 2007

Case Management

Case management is a process that allows direct contact between our case management nurses and our patients in order to improve patient health outcomes. I recently sent a letter to Health First Network physicians with the following important information regarding our enhanced case management programs:

First, we now have available the technical expertise, resources, and predictive modeling tools to identify high-risk patients from claims data and then to apply specific teaching and interventions aimed at decreasing their risk of later complications from their illnesses. The latest evidenced-based-medicine protocols along with individual nurse coaching are used to enhance a patient’s knowledge and compliance with their treatment program.

For more information on what case management can do and how to access it on behalf of patients, please click here. Or, for contact information, including phone numbers and extensions of MED3OOO case management staff, click here.

The Health First Network/MED3OOO case management program is designed to make a primary care physician’s job easier and more effective, as well as to help educate patients about their disease conditions and empower them to better manage their chronic illnesses.

If any physician or clinical office staff member would like to review any of the case management and/or disease management protocols used by Health First Network, please contact the MED3000 Medical Management Department at 850.478.6060.

WellCare Select & WellCare Access: Products Benefiting Practices and Patients

Imagine collecting more money, enjoying less administrative hassle, and reaping the benefits of case and disease management. Then, realize all of these opportunities by tapping into one of two new products unveiled by WellCare earlier this year: WellCare Select and WellCare Access.

WellCare Select and WellCare Access target people who are dual eligible, meaning they qualify for both Medicare and Medicaid. And, they are products worth sharing and learning about because they stand to enhance patient coverage and improve practice productivity and profitability.

Consider these advantages offered by WellCare Select and WellCare Access:
•Medicare is primary in these situations; Medicaid is secondary. So, as doctors’ offices bill for the 20 percent coinsurance that Medicare does not cover, Medicaid coordinates benefits and, in most situations, determines there is no additional payment necessary.
•Health First Network will pay 100 percent of Medicare, less any co-pays.
•With WellCare Select and WellCare Access, physician offices rarely need to bill more than once. The elimination of a second billing makes administration easy.
•As with regular WellCare patients, Health First Network employs case management and disease management nurses to help patients deal more effectively with their illnesses. Most physicians place a high value on the network’s case management/disease management services as a way to assist them in the outpatient management of their patients.
•Unlike people who are covered by Medicare only and are subject to an open enrollment period, dual eligible patients can elect to join the plan at any time.

WellCare Select and WellCare Access are worthwhile products; however, Health First Network needs help identifying patients to leverage them because currently there is no available list of people who are dual eligible. This is where our physicians and office administrators can help us help them--by identifying patients and referring them to WellCare.

Jenny Caillouet and Tammy Bruner, of Health First Network, are currently visiting practices to shed additional light on WellCare Select and WellCare Access, distribute brochures, and solicit support in building this program. We encourage participation because it will ultimately benefit patients and practices alike.

For more inormation, please visit www.wellcare.com.

Related Links


Health First Network Community Delves into Pain Management Issues

Pain management. Optimal care. Documentation. Addiction. The law. Concurrent treatment. These were among a wide variety of topics explored during a recent seminar presented by Health First Network. Thirty-three physicians and 12 others, including case managers and social workers, attended the Network’s May seminar, “Managing Chronic Pain…Clinical, Ethical, and Lawful Solutions.”

This timely seminar, followed by a panel discussion, was well received. This is no surprise in light of today’s challenging health care landscape. “Pain management is an intricate subject on many levels,” said Pat Ast, Health First Network’s Director of Health Services. “Physicians across the country are grappling with tough issues related to pain management. We used this seminar as an opportunity to support our doctors by providing them with a wealth of current and practical information.”

Topics included “Has the Diagnosis Been Made?” “Sorting Out & Treating Chronic Pain,” “Management Strategies to Identify/Treat the Addicted Patient,” “Collaboration to Improve Patient Outcome,” and “Prescribing Practice & the Law.”

Here is just a glimpse of what people who attended the pain management seminar walked away with (in their words):
•"Clear guidelines for everyday practice”
•“Better comprehension of current standards of care and recommendations for optimal care of chronic pain”
•“Increased awareness of addiction and psychiatric disorders”
•“Improved liability for adverse outcomes from pain management”
•“New technologies for diagnosing management for chronic pain”

Health First Network offered this seminar as part of its ongoing commitment to act as a valuable resource to physicians.

Health First Network Board News

Since its inception more than 20 years ago, Health First Network has succeeded through a unique integration of flexibility and focus. While the organization has undergone many changes, it has always upheld its mission, which is to improve the health care experience and quality of life of people in this community. This success is due, in great part, to Health First Network’s Board and Executive Committee.

Here is the latest news regarding these two instrumental arms:
•Beginning this August, Dr. William Whibbs, who has served as the network’s part-time medical director for years, will assume the role full-time.
•Dr. Thanh Duong-Wagner is joining the Board of Directors. She is the second woman to join the team and an excellent new addition.
•Dr. Karen Snow will now serve on the Executive Committee in addition to the Board.
•Dr. Patrick Murray is stepping down from the Executive Committee after nearly two decades of service; he will remain on the Board.
•Dr. Franklin Fleischhauer is leaving the Board after nine years of service.

Welcome New Members

Health First Network would like to welcome the most recent physicians who joined the Network:

•Elias Banuelos, M.D. – Family Practice, Sacred Heart Medical Group
•Silwan Chedid, M.D. – Oncology, Sacred Heart Medical Oncology Group
•William J. Dobak, D.O. – OB/GYN, Sacred Heart Medical Group Sub Specialist
•William P. Jones, M.D. – Diagnostic Radiology, The Imaging Center of Pensacola
•William Hass, M.D. – Anesthesiology, Panhandle Anesthesiology Associates PA
•Brittain F. Kulow, M.D. – Dermatology, Emerald Coast Dermatology