Date: Thu, 18 Dec 1997 18:29:42 GMT Server: Stronghold/1.3.4 Ben-SSL/1.3 Apache/1.1.3 Content-type: text/html Content-length: 10388 Last-modified: Wed, 17 Dec 1997 15:28:18 GMT
Advance Paradigm's innovative approach to medical management centers on effective treatment of key disease states that can have significant financial impact on the entire benefit plan. Advance Paradigm utilizes proprietary integrated information technology to monitor the quality and progress of patient care and compliance, and to evaluate provider compliance with treatment and "best practice" guidelines. These disease-specific protocols have been designed by Advance Paradigm's clinical staff of physicians, nurses, and pharmacists using nationally accepted standards of practice through a collaborative effort with several of the nation's top healthcare institutions and acknowledged medical experts. Advance Paradigm provides extensive education for both the providers and the members in order to achieve the most successful outcome possible.Disease Management Advance Paradigm administers customized disease management programs designed to help our clients manage those disease states that can have significant financial impact on the benefit plan in the near term, including diabetes, asthma, and cardiovascular disease. We employ sophisticated case finding tools using proprietary algorithms to identify those members in the population most at risk for adverse medical outcomes. Our program protocols have been developed using nationally recognized guidelines and are designed around a total quality management process that incorporates NCQA standards. Intervention strategies include a combination of provider and patient communication, education, feedback, and administrative incentives that help optimize behavior and quality of care.
Care Management Advance Paradigm's care management component strategically integrates multiple health services into a focused delivery system of beneficial and cost- effective patient interventions. By following a disease-specific, outcome-based critical pathway model of care, managed care nurses can ensure that key activities are identified, coordinated, and performed in a timely sequence. As each encounter or event is benchmarked against predictable results, every episode of care becomes an opportunity to improve future care and compliance. Advance Paradigm provides comprehensive guidelines for each of our health services, which include skilled nursing care, physical and occupational therapies, in-home diagnostic services, and other ancillary programs such as respiratory or infusion therapies. Advance Paradigm's care management protocols can be administered by our client's care management team or provided by Advance Paradigm's staff.
Outcomes Management Information management is the key ingredient in performing effective outcomes management. Using evidence from peer review medical journals, Advance Paradigm's disease management programs are routinely evaluated against quantifiable milestones and are continually modified to assure optimal results. The evaluation process is facilitated through the use of MedQuery, Advance Paradigm's proprietary decision support system.
Current Initiatives Disease Management
Program Components
* Asthma * Upper GI * Otitis Media * Diabetes * Hypertension * Cardiovascular Secondary Risk Reduction Case Finding Tools
* Clinical Care Protocols * NCQA HEDIS Programs * Patient Case Findings * Interventions: * Patient and MD Compliance A. Care Management * Disease-Specific Outcomes Analysis B. Population Management * "Global" Cost and Savings Analysis Information Management is an essential resource in disease management. Advance Paradigm utilizes MedQuery, our sophisticated decision support system, to apply proprietary case finding algorithms to an integrated rendered-care data set. This allows us to identify those members at highest risk for adverse medical outcomes so that appropriate intervention strategies can be implemented.
Financial Impact by Disease StateAdvance Paradigm's disease management programs are designed to focus on key disease states that can significantly affect plan costs and quality. The following charts illustrate those disease states having the greatest overall impact.
Critical PathwaysThe critical pathway is the process by which we identify and deliver the most appropriate level of care to the individual patient and ultimately to groups of patients.
- Assess baseline health and functional status.
- Identify diagnosis/disease.
- Evaluate complicating medical conditions.
- Respond to socioeconomic circumstances that impede progress.
- Provide intervention and teaching necessary to manage the disease.
- Coordinate the communication and service of ancillary interventions.
Patient Education
- This process enables us to quickly assess where the individual is positioned on the health-illness continuum through our initial assessment and then to go forward with a manageable plan to achieve specific results (outcomes) within a specific time.
- The progress toward goals is measured with each encounter, thereby allowing the plan of care to serve the patient. We remain focused on what is working for the benefit of the patient, and we always know at what cost we are achieving these outcomes.
Ancillary Services
- A combination of written materials, videotapes, and verbal instructions are used to educate the patient or the patient caregiver about the disease process.
- Through this educational focus, the patient learns how to modify his or her lifestyle and thereby reduce unnecessary risk factors.
- The investment in patient education is worthwhile because noncompliant patients create significant additional costs to the health care system through unnecessary hospital readmissions or emergency room visits.
Diagnostic services include:
Health Care Team
* Twelve-lead EKG monitoring * Digital pulse oximetry/arterial blood gases * Complete blood count (CBC) * Chest X-ray * Carotid and/or venous Doppler study
- The health care team consists of a managed care nurse, an occupational therapist, a dietitian, and a medical social worker.
- The managed care nurse coordinates the entire care process of the patient and schedules other interventions and ancillary services as necessary to achieve the desired outcomes.
Outcomes Analysis
- Advance Paradigm's programs are designed to assess the impact of specific interventions on the overall cost and quality of care within your health plan.
- Outcomes analysis is performed through a review of fully integrated rendered-care data sets, including medical, lab, and pharmacy claims data. Integration is accomplished through MedQuery, our decision support system.