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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

May 2014

Comprehensive Approach to Disease Management 


In this installment of our ongoing series on the Integrated Risk Bearing Organization (IRBO) Initiative, we provide an overview of Harvard Pilgrim’s disease management programs and how they support the goals of this initiative.

The IRBO Initiative fosters the principles of the patient-centered medical home and Accountable Care Organizations (ACO), or Centered Care.  Among the primary goals of this initiative is promoting comprehensive care (bringing together a team of providers to be accountable for the patient’s spectrum of needs) and patient-centered care (supporting patients in being well-informed and enabling them to manage their own health), and our disease management programs play a vital role in both.

Coordinating Resources, Empowering Patients
Harvard Pilgrim takes a comprehensive patient-centered approach to disease management, developing programs that coordinate resources across the health care delivery system and throughout the life cycle of a disease. Harvard Pilgrim’s disease management programs include a range of components specifically designed to reinforce clinicians’ treatment plans.

Harvard Pilgrim’s disease management programs are available to all of our members, and the success of these programs will also make them a centerpiece of the IRBO initiative. Our disease management programs assist patients with conditions such as asthma, COPD, heart failure, and diabetes by helping them better understand their condition, giving them new information about their disease, and providing them with assistance from clinical health educators and pharmacists who can help them manage their disease.

Automatic Member Outreach
Harvard Pilgrim identifies specific patient populations — those with a chronic condition such as diabetes, heart failure, or asthma — and automatically enrolls them in our disease management programs. We identify patients for these programs in a number of ways:

  • referrals by their physicians, case managers, and specialty care providers
  • census reports from hospital or ER visits
  • medical and pharmacy claims analysis that identifies patients with appropriate diagnoses
  • self referral
  • health risk appraisal

Programs vary by disease. As an example, the diabetes program aims to help members control their diabetes and improve self-management skills. Components include support from a diabetes nurse educator; periodic reminders about important diabetes tests including HbA1c, nephropathy, LDL screenings, and diabetic retinal exams; patient education materials; free glucose meters; and free smoking cessation resources.

For a full list of all of Harvard Pilgrim’s disease management programs, and details on what each program entails, please visit our Disease and Health Risk Management page. To enroll a Harvard Pilgrim member into one of our programs, e-mail healthandwellness@harvardpilgrim.org or call
866-750-2068.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,
Editor

Kristin Edmonston,
Production Coordinator