MainCare Care Management Program

Descripción de la práctica:
This project continues a demonstration to develop managed care program for dually eligible Medicare and Medicaid beneficiaries. The purpose of the demonstration is, co-funded by the Robert Wood Johnson Foundation, to enhance the clinical and administrative coordination of primary, acute, and long term care services for adults and elderly Medicaid beneficiaries. MaineNET is an entirely voluntary program with primary and acute services for all eligible beneficiaries managed through a contracting primary physician. Medicare and Medicaid claims information is used to monitor program impact. Utilization and cost data is shared with primary physicians to facilitate patient education as well as improve service arrangements. The program manages all diseases of its members, with the most common being: Asthma, Cardiovascular diseases, Diabetes, Depression, and Lower Back Pain and benefits patients with: • multiple chronic conditions, • multiple medications, • in need of self-management education, • with special needs • whose medical care is complicated by depression • with multiple emergency room or inpatient admissions and • in need coordination of multiple services for their medical needs

Otra información de interés:
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