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Dr. Jennifer D. Gholson

Last year, Colorado-based McKesson Health Solutions, a nationally recognized leader in disease management services for Medicaid beneficiaries, invited 20,000 Mississippians with heart disease and/or diabetes to participate in a voluntary three-year Medicare Health Support pilot program.

The landmark population-based disease management program was designed to improve the health and wellness of people living with multiple chronic illnesses and to help participants comply with their physicians' plans of care to reduce health risks.

McKesson, which is administering the program in Mississippi, reviewed historical claims to identify patients who qualified for the program. The Centers for Medicare & Medicaid Services (CMS), which is supervising the program, randomized 21,000 patients for the intervention group and 10,000 beneficiaries for the control group. More than 34 healthcare organizations, including the Mississippi State Medical Association and Mississippi Academy of Family Physicians, endorsed the pilot program.

"We're very pleased to have 17,000 in the program and we're adding more," said Dr. Jennifer D. Gholson, the state medical advisor for McKesson. "It really demonstrates how much the program is needed in Mississippi, where cardiovascular disease is the leading cause of death."

Medicare Health Support's delivery model is designed to support selected beneficiaries via telephonic and community-based care management, nursing home-based care, complex case management and end-of-life care.

Beneficiaries receive educational material by mail, have access to round-the-clock telephone care by triage nurses, and may qualify for home monitoring devices, all free of charge.

Of the 75 registered nurses (RNs) who work in Mississippi, 33 are community-based nurses who provide in-person care coordination on health issues for people with social, language or cognitive impairment.

Some 42 RNs man the phones at the McKesson call center located at the Jackson Medical Mall Thad Cochran Center.

"We installed a telemonitoring device in the home of one lady who was having red alerts almost daily," said Gholson. "The RN who handles red alert calls found that this particular patient, prior to us installing the device in her home, was frequently in the emergency room and hospital. Now, she's hardly had any ER or hospital visits because she's getting her needs reinforced and she's being educated about what's causing her to red flag and what dietary changes she should make."

The program, which also has a pharmacist, a physician and a program manager, assists physicians with eligible patients by providing quarterly funding and tools, such as data-recording software. The compensation model is based on timely payments, early rewards for participation, implementation of widely accepted clinic practices such as aspirin therapy for diabetics, and fair payments to reflect the work performed. Field providers coordinate care with physicians.

Last month, the University of Mississippi Medical Center (UMC) and McKesson began providing an additional service to Mississippians participating in the CMS program: providing diabetes management classes to approximately 1,000 randomly selected beneficiaries living in Hinds, Madison and Rankin counties. The classes, developed and delivered by UMC experts, will help participants learn more about the effect of diabetes on their overall health, benefits of self-management, medications used to treat the disease, and ways to talk with healthcare providers about diabetes. The educational series, geared to the elderly population, consists of three 1-hour informal lectures with an additional 30-minute Q&A session.

"We're encouraging everyone who has the opportunity to go to these sessions," said Gholson. "The information available can help beneficiaries learn the best ways to manage diabetes and to talk with their healthcare provider about ways to control this chronic illness."

After the pilot program ends in August 2008, CMS may expand the program to all qualifying beneficiaries.

"We're very excited about what we're doing in Mississippi and the progress we've made," said Gholson. "We want to continue to keep our beneficiaries engaged in the program and how to best serve the needs of our nursing home population and we're exploring new ways to engage physicians to participate in this program."

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