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Member Management Using The Med-eXpert System and Med-eMonitor Patient Appliance. Mary Gardner, RN, MA, CCM, CDE Program Manager, High Risk Diabetes and COPD XLHealth. Objectives.

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member management using the med expert system and med emonitor patient appliance

Member Management Using TheMed-eXpert System and Med-eMonitor Patient Appliance

Mary Gardner, RN, MA, CCM, CDE

Program Manager, High Risk Diabetes and COPD

XLHealth

objectives
Objectives

To provide information on the previous use and implementation of the Med-eXpert System, which links together patients using the Med eMonitor Patient Appliance, the ADT call center, and XLHealth Care Managers

the med expert system
Confidential and Proprietary The Med-eXpert System

Patient Appliance

Med-eMonitor™

Patients

Care Givers

Med-eXpert™ Information Repository

ADT Monitoring Center

XLHealth Care Manager

target population
Target Population

Diabetes Members with Heart Failure

  • Voluntary agreement
  • Provider contact approval
med expert system
Med eXpert System

What Can It Do?

  • Patient’s Med-eMonitor linked to Med-eXpert database, appliance sounds an alarm at the time of medication dosage or care plan activity (answer health query, self-care check, clinic visit)
  • Records when the member takes their medications - it then sends the information to a secure site where a Care Manager will review it
  • Sends automated alerts if the member is not taking their medications properly, experiences any side effects, or the responses indicate a potential health risk
  • Information is confirmed with member and appropriate action is taken to facilitate medication adherence
med expert care plan guidelines
Med-eXpert Care Plan Guidelines

Medication - Guidelines

  • Daily
    • Reminder(s) to take medicines
    • Confirm adherence or non-adherence
    • Solicit reasons for non-adherence
  • Monthly
    • Contact to determine if have had:
      • Any medication changes
med expert care plan guidelines cont d
Med-eXpert Care Plan Guidelines (cont’d)

Intervention - Guidelines

  • Weekly
    • Reminder to test glucose, and enter levels into Med-eMonitor appliance
    • Reminder to follow healthy meal plan
    • Reminder to inspect feet and wear protective footwear
  • Monthly
    • Contact to determine if have had:
      • Any ER visits this month
      • Any hospitalization this month
medication adherence care plan goals
Medication AdherenceCare Plan - Goals

Long-Term Goal:

  • Member will take medications as prescribed by their provider to improve health outcomes and reduce health care costs

Short-Term Goal:

  • Member will adhere to their daily

medication regimen as prescribed

by their provider

medication care plan adherence care manager interventions
Medication/Care Plan Adherence Care Manager Interventions

The Med-eXpert System enables Care Manager evaluation of factors affecting Medication and Care Plan Adherence:

  • Medication adherence (e.g. side effects, out of meds, etc.)
  • Financial issues
  • Poor memory
  • Complex dosing regimen
  • Lack of understanding of therapeutic benefit
  • Barriers to diabetes self-care
  • Emotional issues

Evaluates home support system

  • Refer to appropriate resources to maintain safe medication administration

Maintains provider collaboration

Evaluates need for Social Services referral

diabetes care plan goals
DiabetesCare Plan - Goals

Long-Term Goal:

  • Member will follow Diabetes care regimen

prescribed by their provider

Short-Term Goal:

  • Member visits provider and specialty providers regularly
  • Member verbalizes understanding of blood glucose targets
  • Member knows the importance of following an individualized healthy meal plan
  • Member practices healthy foot care
diabetes care plan care manager interventions
Diabetes Care PlanCare Manager Interventions

Contacts provider for SBGM frequency, if unknown

Contacts provider for referral to:

  • Dietitian
  • Diabetes Educator
  • Social Services
  • Specialty Providers
    • Endocrinologist, Wound Care Center, Podiatrist, Pedorthist, Vascular Specialist, Opthamologist

Educate members to call their provider for:

  • Significant changes in blood glucose results
  • Episodes of hyper-or hypoglycemia symptoms
foot exam care plan goals
Foot Exam Care Plan - Goals

Long-Term Goal:

  • Will perform daily foot exam
  • Will wear diabetic shoes and inserts daily
  • Podiatrist evaluation is complete and will seek a routine podiatry evaluation at least annually/ ≥ 4 times/year
  • Verbalizes importance of emergent podiatrist appt if rest pain occurs

Short-Term Goal:

  • Verbalizes importance of seeking evaluation

within 48 hours of observing foot problem

  • Will perform daily foot exam
foot exam care plan care manager interventions
Foot Exam Care Plan Care Manager Interventions

Assist member to:

  • Find a Primary Care Physician, if needed
  • Find a Podiatrist, if needed
  • Find a Pedorthist, if needed
  • Find an LEX vascular surgeon, if needed
er visits and admissions
ER Visits and Admissions

To evaluate:

  • Member care needs
    • Regular provider and specialty visits, DME
  • Healthcare compliance
    • Medication regimen, self glucose monitoring, healthy meal plan, healthy foot care
  • Knowledge deficits

To facilitate Care Manager interventions

To Avoid Hospitalizations and ER Visits!!

thank you questions
Thank You!Questions?

Mary Gardner, RN, MA, CCM, CDE

Program Manager, High Risk Diabetes and COPD

XLHealth

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