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 MyHealth's wellness and lifestyle management program was established in 2001. Our disease management program was added in 2003. The founders of MyHealth became increasingly aware that the
majority of techniques for helping to control healthcare costs were
largely ineffective. Plans had tried alternative delivery systems,
increasing participant premiums, deductibles, co-payments, limiting
practitioner panels, and a variety of other processes. These were
designed to increase participant awareness and have them share in
the cost of treatment. Yet, costs continued to spiral upward.
Analysis of participant utilization patterns revealed that, in spite
of approaches to raise awareness, participants continued to utilize
physicians and treatment facilities inappropriately. There also
appeared to be significant gaps in treatment contact for persons
with chronic disease diagnoses.
Concerns, such as these, were shared across the nation and prompted
members of the medical profession to begin to explore techniques for
better treatment of persons with chronic conditions. The emergence
of evidence based clinical guidelines and their adoption by the
medical profession set the stage for programs that became labeled
disease management.
The MyHealth disease and care management approach utilizes a
combination of medical and pharmacy utilization information that is
matched on a patient by patient basis. The program initially
assesses two years of such data refreshed monthly. These data are
processed through a complex series of filters and clinical
algorithms in order to define a risk level for each program
participant. Patients who are found to have one of the 20 different
chronic diseases addressed under the MyHealth program are assigned
to a MyHealth nurse who works with them to develop a self-treatment
plan. The self-treatment plan focuses on the patient’s knowledge,
skill and motivational requirements for implementing a program to
enhance self care. Each patient is monitored over time and interacts
on a regular basis with their MyHealth nurse.
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