CustomCare Programs

After the Hospital and TLC

Tracy Lin, PharmD, CACP After the Hospital

At Home

TLC

2Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

CustomCare Model

3Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

CustomCare After the Hospital Helps patients get on the path to recovery after hospitalization

CustomCare At Home Takes care of patients who need care in their home environment

CustomCareTLC

Helps improve quality of life for those with multiple health conditions

PCP

HealthEducation

HomeBase

Program Clinician

Transition of Care Nurse

Pharmacist

Care Coordinator

SocialWorker

3

-

4Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

CustomCare After the Hospital

Helps patientsget on the path to recovery after hospitalization.

After the Hospital

At Home

TLC

Dedicated provider

(not the PCP)

Team Includes:

CareCoordinator

Transition of Care Nurse

Social Worker

Pharmacist

CustomCare After the Hospital: How It WorksGoal: To reduce readmissions and complications for our patients

• Transition of Care Nurses (TOCNs) or other CMG team members schedule follow-up appointments for Medicare Advantage patients within 72 hours of discharge from the hospital

• Provider recaps the patient’s hospital stay and focuses on chronic conditions that may have the potential to decompensate acutely

• Gaps in care should be identified and addressed where relevant

• Referrals to specialty care are evaluated. Nurse is present during the appointment and can help verify whether or not referrals need to be placed or are already present in the medical record

• Follow-up labs that could potentially affect patient management within 30 days post- discharge should be ordered by provider

• Medication review and reconciliation by the pharmacist

• Follow-up appointments are scheduled on behalf of the patient

Pharmacist Workflow

6Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

Pharmacist preps patient chart. Pharmacist + Provider discuss potential improvements to medication therapy prior to patient arrival.

Provider + Nurse see and evaluate the patient.

Pharmacist + Patient review and reconcile medications.

Pharmacist + Provider review any medication changes that occurred during appointment.

Team discusses any discrepancies or issues that need further action.

Pharmacist Interventions

• Medications reviewed, medication list reconciled, patient counseled

• Medication list/card provided

• Medication list updated (after provider)

• High Risk Medication (HRM) identified

• Medication cost savings identified

• Comprehension medication review (CMR) documented (for MTM)

• Adverse effects identified

7Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

• OTC counseling/recommendation made

• INR checked (if applicable)

• Duplication of therapy identified

• Drug-drug interaction

• Drug-disease interaction

• ACE/ARB recommended

• Lab issues identified

• ASA addition recommended

• The teach back technique was used for inhaler and/or devices

• Other (Referrals, etc.)

8Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2011 Cigna

CustomCare TLC

Team Includes:

After the Hospital

At Home

TLC

Helps improve quality of life for those with multiple health conditions.

Dedicated provider

(not the PCP)

CareCoordinator

Nurse

Social Worker

Pharmacist

CustomCare TLC Goal: To teach patients to live with their chronic disease state(s)

successfully and ideally maximize their quality of life

• Identify high risk patients with disease specific conditions to enroll in the program

• Teach Back Technique – using methods to engage and verify patient’s assimilation of information

• Developing a mutually agreed upon plan with the patient to manage any changes in their condition(s)

• R-E-M-E-D-Y Modules

1Plan performance summary star ratings are assessed each year and may change from one year to the next.“Cigna” is a registered service mark, and the “Tree of Life” logo, "GO YOU" and “Cigna Medical Group” are service marks, of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and Cigna HealthCare of Arizona, Inc., and not by Cigna Corporation. Cigna Medical Group (CMG) is an operating division of Cigna HealthCare of Arizona, Inc. All models are used for illustrative purposes only.

© 2013 Cigna

Cigna Medical Group is a NCQA recognized

Patient-Centered Medical Home