Member Services: 877-514-2442

POPULATION HEALTH MANAGEMENT

To ensure optimal clinical outcomes

CGHC’s Population Health Management (PHM) programs and activities were implemented to ensure clinical outcomes and processes, cost/utilization, and member experience meet organizational expectations. CGHC uses various types and sources of data to help us understand the care needs of our member population and relevant sub-populations. In addition, CGHC utilizes multiple data sources to monitor, analyze, and evaluate the PHM programs and planned activities.

CGHC’s PHM programs and activities focus on medical, behavioral health care, and pharmaceutical programs and benefits, and the degree in which they are coordinated to improve the health of CGHC’s member population. We use a systematic approach to ensure program coordination to reduce multiple contacts and member burden. CGHC’s PHM programs and activities are reviewed, updated and approved by CGHC’s Executive Quality Oversight Committee (EQOC) at least annually.

CGHC’s 2020 PHM programs and activities include specific areas of focus that address the following below. CGHC will notify specific members who qualify for these programs via phone call, email or mailing (for members who can’t be reached by phone or email).

Keeping members healthy: 

    • Children and Adolescent Preventive Care: CGHC children and adolescents to receive their necessary preventive services in 2020 from a contracted CGHC practitioner’s office or contracted pharmacy, at no cost.
    • Adult Preventive Care: CGHC adult members 18 and older to receive their necessary preventive services in 2020 from a contracted CGHC practitioner’s office or contracted pharmacy, at no cost.

Managing members with emerging risk

    • Statin Therapy for Members with Diabetes: CGHC members with a confirmed diagnosis of diabetes, ages 40 to 75 to start and continue taking a statin medication in 2020 to control individual cardiovascular risk factors by preventing or slowing Atherosclerotic Cardiovascular Disease in people with diabetes.
    • Diabetic Eye Exams: CGHC diabetic members to receive the necessary diabetic eye exam to detect eye problems such as diabetic retinopathy, glaucoma, and other eye problems early in 2020.
    • Medication Management for Members with Asthma: CGHC members diagnosed with persistent asthma ages 5–64 years of age to continue taking their asthma controller medication to reduce airway inflammation and help prevent asthma symptoms from occurring in 2020.

Patient Safety – Improve the safety of high-alert medications

    • CGHC’s Opioid Management Program: CGHC members who are “first fill” opioid utilizers to provide education and discussions with a pharmacist to prevent inappropriate utilization.
    • Monitoring Members on Warfarin Therapy: CGHC members who are dispensed warfarin for at least 56 days receive at least one international normalized ratio (INR) monitoring lab test, for each 56-day interval with active warfarin therapy to reduce the occurrence of preventable adverse drug events in 2020.

Managing multiple chronic illnesses: 

    • CGHC Members Enrolled in Complex Case Management: CGHC members who are currently enrolled in Case Management who had an inpatient stay will receive a post-discharge assessment and transition of care plan completed in 2020.