MEDecision's URAC-accredited Alineo Clinical Programs are a
combination of condition-specific, fully integrated clinical
knowledge and sophisticated support tools designed to improve both
the cost and quality of care.
Clinical Programs are comprised of assessments that drive care
plans. Short assessments provide a focused evaluation tool to
address the member's immediate needs. The more comprehensive full
assessments are used during the ongoing interactions between the
member and the care manager. They include the key components that a
care manager must address to satisfy the URAC accreditation
requirements.
Clinical Programs also includes electronic patient engagement
tools and other materials intended to facilitate member care
management by documenting and tracking the care management process,
particularly in the following areas:
- Current Health Status
- Clinical History
- Treatment Plan
- Medication Safety
- Medication Reconciliation
- Resources Needed to Meet Immediate Health Needs
- Care coordination Needs
- Psychosocial Status
- Safety Concerns
The assessments included in Alineo Clinical Programs enable care
managers to help members recognize and address potential health
concerns. The responses to questions included in the assessment
generate suggested actionable interventions derived from
evidence-based medicine and national guidelines and best practices
protocols. Case managers also use this information to formulate
specific individualized plans of care that incorporate the health
plan's criteria for short- and long-term goals and to develop
reports on the progress and outcomes associated with the
recommended interventions.
Each Alineo Clinical Programs assessment provides guidance with
an integrated "Help" feature designed to increase the care
manager's depth of knowledge and their ability to identify
subtleties, investigate certain issues and provide members with
resources that significantly impact their outcomes, quality of life
and satisfaction. Some Helps are linked to embedded, comprehensive
medication lists to enable care managers stay current with the
rapidly changing pharmaceutical landscape. Supporting documentation
- such as templates for letters to members and providers - offers
additional knowledge exchange and education.
Also, Alineo Clinical Programs feature interactive patient
engagement and education capabilities provided through a strategic
alliance between MEDecision and Emmi Solutions, LLC. MEDecision's
health plan customers can provide their members with email links to
Emmi® programs - interactive and trackable Web-based content
regarding certain conditions, procedures, medications and related
information specific to the individual patient. For example, a
patient with asthma deemed to be incorrectly or inconsistently
using an inhaler may be sent a link to an Emmi program
demonstrating how to better use the device. The member may then
interact with their care manager through the Emmi program by
securely submitting any questions or comments. The care manager, in
turn, can track the patient's progress or non-compliance and
communicate accordingly.
Alineo Clinical Programs work synergistically with
Nexalign® Clinical Intelligence Rules to identify gaps in care
and treatment opportunities. This enables care managers and
providers to work more collaboratively to improve the member's
health status and care quality while managing costs and optimizing
efficiencies.
MEDecision achieved URAC accreditation for Alineo Clinical
Programs in October 2010, which can assist health plans in their
own URAC accreditation efforts.
Alineo Clinical Programs also give organizations the capability
to create new clinical programs to accommodate their specific
needs. However, the benefits of MEDecision's URAC accreditation
will not extend to any custom-built programs.
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