S.C. Medical Home Pilot for Diabetes Enr...( COLUMBIA S.C. and NORTH C...),Health

COLUMBIA, S.C. and NORTH CHARLESTON, S.C., July 27 /PRNewswire-USNewswire/ -- A patient centered medical home pilot project that could become a model for South Carolina has completed its first quarter with 1,110 patients enrolled. It is also attracting the attention of S.C. physicians not involved in the program, and S.C. businesses are interested in it as a means to managing their health care costs.

The project, a year-long collaboration started in April, is focusing on diabetic patients who are members of BlueCross BlueShield of South Carolina, BlueChoice HealthPlan of South Carolina, and the State Health Plan and who are patients of Palmetto Primary Care Physicians in the Charleston, S.C., area.

Patient centered medical homes integrate quality improvement, coordinated care management and patient educational services into primary care practices. The concept places the primary care doctor in charge of a team that can include social workers, pharmacists, wellness coordinators, nurses, disease managers, certified diabetic educators, dieticians and pharmacists all working together to proactively reach out and develop an individual treatment plan for patients.

In the first three months, case managers hired for the project have contacted 60 percent of the eligible patients to explain the concept, to gather baseline health data, and to encourage them to use an online portal that contains tools that help manage their disease and enable them to have "e-visits" with a physician.

The case managers aim to reduce gaps in care, such as missed appointments with specialists, and lifestyle issues such as medication adherence. They also perform outreach, such as registering patients for diabetic education, scheduling appointments with specialists, providing discount vouchers for medications, offering discounted memberships to local gyms, and monitoring quality processes and o
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