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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) and forwarded to the Board of Directors at least annually.

CGHC’s 2019 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: 

    • Annual Flu Shots: CGHC members to receive influenza vaccine from a contracted CGHC practitioner’s office or contracted pharmacy, at no cost in 2019. (CGHC to identify through medical and pharmacy claims).
    • Breast Cancer Screenings: CGHC female members ages 50-74 to receive screening mammogram from contracted CGHC providers, at no cost in 2019.

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 2019.
    • 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.

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 Taking a prescribed ACE/ARB/Diuretic Medication: CGHC members 18 years or older who have taken an angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB) or diuretic Medication to obtain the necessary therapeutic monitoring lab test in an effort to reduce the occurrence of preventable adverse drug events.

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.