Health Management
Through an arrangement with South Carolina's largest insurer, PAI is pleased to offer the Health Management program to self-funded plans with the Preferred Provider Network.
Health Management helps members with chronic medical conditions such as diabetes, heart disease, or chronic respiratory conditions better understand their doctor's instructions and improve the way they care for themselves each day:
- An estimated 10-20% of a given population will be affected by one or more of these chronic conditions.
- South Carolina's largest insurer initially developed the program for a group with 40,000 members. Significant positive impacts of disease management on that membership group, indicated in utilization and cost performance reports, led to the rollout of this program.
Health Management targets members with chronic illnesses with the objectives of improving their health status and self-management skills, reducing hospital admissions and inappropriate emergency room use, and enhancing member satisfaction. Chronic conditions require attention 24 hours a day, seven days a week, and most patients provide 95% of their care themselves. Each month, eligible participants will receive invitations to take part in the program. Physician referrals and self-referrals are also welcome.
Members join the program by taking a confidential survey online or by calling our automated survey line. Based on their survey answers, members are classified by their current risk level, knowledge of their disease, and self-management skills. This lets our Health Management case managers know what type of information and support the patient needs. Case managers, who are registered nurses with experience in disease management, provide the patients with individually tailored health materials, resources, and support to help them work with their physician and develop a self-care plan to take charge of their illness.
Health Management is another example of how PAI works hard to provide our customers with outstanding benefits and better care.