Today’s care manager is often faced with challenging members who require more complex care management. Many people struggle with a variety of chronic conditions and may not have the knowledge or wherewithal to effectively interact with the health care system. Others simply have a difficult time engaging with their doctors, which compromises the effectiveness and efficiency of their care.
Alineo Clinical Programs equip health care payers with advanced resources to better address these situations. Alineo Clinical Programs is a set of 30 clinical programs that help simplify the management of members with chronic diseases and those with complex health concerns that require case management. They include a disease-specific health risk assessment, plan of care content (problem list, goals, barriers, interventions and outcomes), member educational material, recommended measures for reporting plan progress and the effectiveness of a case or disease management program and a recommended risk-based intervention schedule for each module. The programs are embedded in the Alineo workflow for maximum consistency and efficiency.
Each Alineo Clinical Program is based on a comprehensive review of the medical literature using recognized, publicly available national standards and evidenced-based clinical practice guidelines with the content complete toolkit of member and physician correspondence tailored to member-specific problems and interventions. These are derived from a multi-dimensional health risk assessment that determines the severity of each condition along with the member’s readiness to change, daily living activities and condition interdependencies.
The various Alineo Clinical Programs are based on nationally recognized clinical information for each disease state and create a basis for member education and intervention strategies. The programs provide condition-specific assessments and opportunities for targeted education to improve health outcomes. Members learn about their individual disease state, medications, lifestyle issues and adherence to their provider’s treatment plan.
Alineo Clinical Programs includes a clinical module with which case managers can assess common risk factors that will affect member outcomes across the care continuum. The health risk assessment provides the tool for the care manager to assess specific areas of clinical management based on national clinical practice guidelines. These include the following types of disease-specific information common across all programs:
- Depression screening
- Controlled risk factor assessments (e.g., tobacco use, weight, BMI, alcohol use)
- Treatment adherence and self-care practices
- Medication contraindications versus noncompliance determination
- Medication non-adherence issues (“Do you take your medications exactly as your provider recommends?”)
- Healthcare utilization: Assessment of routine medical evaluation and/or testing
- Annual flu shot assessment
- Readiness to change assessment