Table of Contents

Care Team Disease Management Programs
DVT Guidelines Available
The Center for Women's Health & Medicine at Mercy
Potential Relief for Migraine Sufferers
Management of Neurobehavioral Disorders by the PCP
Treating Cardiovascular Risk in Diabetics
Pregnancy Case Management
Palliative Care, Hospice and Other Alternatives for the Terminally Ill
Our QI Program
Varicella Reminder
Philosophy of Care
Physician Seminars 2001


Care Team Disease Management Programs

CareFirst BlueCross BlueShield (CareFirst) and its affiliated HMOs - FreeState Health Plan, Inc. and CapitalCare, Inc. - are pleased to introduce new and expanded Care Team disease management programs. The programs are designed for eligible members with diabetes types 1 and 2, diabetes in combination with cardiovascular disease (or cardiovascular disease alone), asthma and cancer.

Our Care Team programs for diabetes and cardiovascular disease target high-risk patients, educate them about their condition and encourage compliance with their physician's treatment plan. Our asthma program educates members on avoiding the preventable complications of their condition. Finally, our cancer Care Team program seeks to ensure the best possible outcomes for members with cancer using evidence-based treatment guidelines and an enhanced patient support network of seasoned oncology nurses.

CareFirst, FreeState and CapitalCare have contracted with Health Management Corporation (HMC) and Quality Oncology to create the new and expanded Care Team programs. Under the direction of CareFirst's Medical Affairs Division, HMC and Quality Oncology will work directly with eligible members and their physicians to offer patients support and encourage compliance with their physician's treatment plans. HMC and Quality Oncology make qualified nurses available to enrolled members at all times. Participation in any of the Care Team programs is voluntary, confidential and provided at no additional cost. You can expect to be contacted by HMC's or Quality Oncology's nurses regarding patients under your care who might be eligible for a Care Team program. Read on for more information about the new and expanded programs. (Information also is available in the Care Management segment of "My Care First," www.carefirst.com's health and wellness section.)

Our diabetes and coronary artery/congestive heart failure Care Team programs
CareFirst, FreeState and CapitalCare have contracted with HMC to provide health education and disease management programs to our members with diabetes, diabetes in combination with coronary artery disease (CAD) and/or congestive heart failure (CHF), or members with CAD and/or CHF alone. Our diabetes and CAD/CHF Care Team program is designed to help patients better understand and manage their conditions through education and lifestyle modifications and also offers telephonic case management intervention. Our partnership with HMC, a national organization recognized as a two-time C. Everett Koop award winner, is designed to ensure patient compliance with physician treatment plans by developing appropriate interventions for each member at his or her given level of severity.

High-risk members in these programs are assigned an HMC Care Team nurse, whose role is not to offer medical advice but to reinforce the physician's plan of treatment. Care Team nurses work with patients to achieve goals that will positively impact health outcomes. Care Team nurses may call CareFirst, FreeState or CapitalCare members proactively to determine if they or their covered family members may benefit from the diabetes and CAD/CHF programs. All Care Team enrollees will have 24-hour, seven-days-a-week telephone access to qualified RNs who can answer questions about medications, ordered tests or other concerns. High-intensity intervention groups will receive outbound calls from these nurses.

The diabetes and CAD/CHF Care Team programs provide:

• patient educational materials, including self-help monitoring charts, resource listings, self-care tips and a quarterly newsletter
• a patient self-management health assessment and nurse consultation as needed
• a professional help line for patient consultation with registered nurses for any health concerns related to diabetes or heart disease
• a patient summary report for the treating physician
• progress reports every six months for the treating physician on high-intensity level patients

To refer a member into the diabetes and CAD/CHF Care Team disease management programs, physicians can call 800-783-4582.

Our oncology Care Team program
CareFirst, FreeState and CapitalCare have contracted with Quality Oncology to introduce a cancer management program for adult members newly diagnosed with cancer, those experiencing a recurrence or adult members undergoing active cancer treatment.* When faced with a cancer diagnosis, patients and their families have many choices and decisions to make. Understanding the delivery of medical care can become confusing and frustrating. Quality Oncology can help patients navigate the often complex and challenging maze of cancer treatment.

Quality Oncology shares our belief that support of a patient's treatment plan through frequent nurse-to-patient communication and monitoring can help improve the chances of a favorable outcome. CareFirst, FreeState and CapitalCare members enrolled in the cancer Care Team program are assigned to a Quality Oncology nurse who monitors their progress in conjunction with the treating physician's care plan. Quality Oncology's nurses are available by telephone 24 hours a day, seven days a week. They provide education regarding chemotherapy and radiation therapy, pain management and other concerns and can assist with facilitating arrangements for home health, hospice and other services provided under their health benefit plan.

Contact Quality Oncology when providing services to any members ordinarily requiring cancer-related authorizations (per the member's benefit plan). To request urgent services (those needed within 24 hours), call Quality Oncology at 888-245-5407. Nonurgent requests should be faxed on the appropriate form (a copy of which has been mailed to oncologists) to 888-871-8426. If none of your patients ordinarily require authorizations for cancer-related services, in the future you must fax the notification form (also mailed to oncologists earlier this month) and your treatment plan for these patients to Quality Oncology at 888-871-8426.

The above procedures apply to all oncology services, including those listed below:

• pretreatment diagnostic test or procedures
• radiation therapy and immunotherapy
• chemotherapy (including initial treatment)
• hormonal therapy (excluding maintenance Lupron, Zolodex, Megace or tamoxifen therapy)
• inpatient treatment (whether in a hospital, hospice or facilities for subacute care, skilled nursing or transitional care)
• surgery
• postoperative treatment
• palliative care

Quality Oncology's parent company, LifeMetrix, Inc. hosts an informational cancer Web site at www.cancerpage.com.

Our asthma Care Team program
Our existing asthma management program has been enhanced with the introduction of telephonic outreach to our members with persistent asthma. CareFirst, FreeState and CapitalCare members with asthma will continue to receive our educational Asthma Control bulletins. Newly identified members with asthma will be added to the educational mailing list. They also will receive a new member packet that contains self-care educational materials like pamphlets on asthma medicines and inhaler and peak flow meter use, calendar reminder stickers and a helpful resource sheet. For more information, contact our Department of Disease Management and Health Promotions at 410-528-7997 or 800-323-4472.

*The following members are not eligible: those under the age of 18, those with basal and squamous cell skin cancers and carcinoma in situ, those in hospice or those previously treated for cancer who are no longer in active treatment. Members with Medigap coverage and FEP enrollees also are excluded.

DVT Guidelines Available

CareFirst has adopted guidelines for the outpatient treatment of deep vein thrombosis (DVT) with low molecular weight heparin (LMWH). These guidelines were developed in consensus with a number of area health plans and their respective physician committees. The guidelines are based upon strong evidence-based medicine and broad input from both primary and specialty care physicians in the community. Current medical data supports the use of LMWH in patients carefully screened for outpatient DVT treatment. (Supporting references from peer-reviewed medical literature are available upon request.) The guidelines encourage early discharge or outpatient management of DVT when appropriate via LMWH treatment and patient education. Candidates for discharge to home care should be referred to Case Management for coordination of home health treatment. The guidelines will soon be mailed to all PCPs who treat adults. Advance copies of the guidelines, references and sample protocol order sheets are available by calling 202-479-8747. We urge you to adopt the guidelines into your standard clinical practice. For more information, you may call Robert M. Thomas, Medical Director, at 202-479-6511.

The Center for Women's Health & Medicine at Mercy:
Leading the Way in Specialty Women's Health Care

The following is presented in an effort to highlight hospital "best practice" around the region. CareFirst wants to share with you the innovative ways in which D.C., Maryland and Virginia hospitals are improving quality of care while controlling the rising cost of health care. Look for additional "best practice" features in future issues of HealthInk.

Physician leadership, integral to every Center of Excellence within Mercy Medical Center, has brought national recognition to The Center for Women's Health & Medicine at Mercy. In fact, The Center for Women's Health & Medicine at Mercy has been named one of the Top Ten Women's Centers in the United States. Mercy's physician experts champion clinical advancements, conduct vital research and serve as patient advocates on "The Woman's Doctor," a news program on Baltimore's WBAL-TV dedicated to the education and awareness of health and lifestyle issues.

"Mercy builds successful programs based on one fundamental principle: We provide physicians with the tools they need to build and sustain strong physician-patient relations," explains Neil B. Rosenshein, M.D., director of The Center for Women's Health & Medicine. Dr. Rosenshein works in tandem with Mercy's senior management team and the Center's physician leadership to provide programmatic, facility-related and strategic direction. He adds, "The Center for Women's Health & Medicine seeks to find the best-in-practice - that means state-of-the-art equipment, upgraded facilities, innovative programs and clinical experts who are leading the way in new treatment options."

Dr. Rosenshein also serves as medical director for The Gynecology Center at Mercy. He has earned a world-renowned reputation in Gynecologic Oncology and is credited with pioneering surgical treatments in all areas of genital tract cancers. The Gynecology Center's clinical team also includes surgeon Dwight Im, M.D., Wendy Riekers, PA-C, and clinical nurse Elaine Vaughn, R.N. Breast cancer continues to affect women at alarming rates, which is why The Breast Center at Mercy makes a concerted effort to participate in clinical trials. Says director Neil B. Friedman, M.D., "Finding a cure is paramount - second only to treating the patient who is enduring the devastation cancer brings to a family." At the national level, The Breast Center at Mercy is currently one of the select sites for the Protocol B-32, Star and NAFTA trials. (Protocol B-32 is a randomized Phase-3 clinical trial to compare sentinel node resection to conventional axillary dissection in clinically node negative breast cancer patients. The STAR trial is a study of tamoxifen and raloxifene for the prevention of breast cancer, and NAFTA is a Phase-2 study of tamoxifen vs. toreminfene as an adjunct therapy for women with carcinoma of the breast.) The Breast Center's clinical team includes Drs. Friedman and Eric Whitacre, Barbara Ashley, CRNP, and Marsha Oakley, R.N.

With the many sensitivities women face regarding cancer and their own body image, Mercy has expanded its service line to include two new centers: Plastic & Reconstructive Surgery and The Center for Health and Restoration. Under the skilled eye of nationally acclaimed surgeon Bernard W. Chang, M.D., a woman's own fatty tissue is used to rebuild her breast - a technique that increases the body's acceptance of the new tissue and gives the patient an easier transition to her daily routine. Mercy's Plastic & Reconstructive Surgery team of Drs. Chang and Armando Soto offer patients this and other special techniques that are available at only a few centers throughout the world.

The Center for Health & Restoration, led by Donna Mack, R.N., complements medical treatment with support care services such as postoperative camouflage makeup application, pre- and postoperative skin-care treatments and micropigmentation for post-breast reconstruction patients.

With the growing number of baby boomers transitioning from postpregnancy to midlife years, The Center for Women's Health & Medicine at Mercy has expanded clinical services to respond to their needs. Fermin Barrueto, M.D., and Wende Allen, PA-C, bring exceptional skill to pelvic reconstruction and gynecologic endoscopy. By precisely diagnosing complex problems such as endometriosis, fibroid tumors, uterine bleeding, infertility and incontinence, minimally invasive treatments can be tailored to each woman's specific need.

The expertise brought by Marcella Roenneburg, M.D., complements the program by extending specialized care in the areas of geriatric GYN, general GYN, vaginal prolapse, urinary incontinence and urinary frequency and urgency. With a special interest in urogynecology, Dr. Roenneburg has taken an active role in educating women that incontinence is not necessarily a part of the aging process.

Underlying the Centers of Excellence for Mercy's patients is a dedicated Women's Imaging program headed by Marcia Javitt, M.D. Physicians have access to comprehensive diagnostic services such as pelvic sonograms, CAT scans, MRIs and bone densitometry. Helen Mrose, M.D., leads breast imaging.

With a wealth of colleague expertise and clinical innovations at their disposal, Mercy's doctors are able to focus on comprehensive patient care. "We build excellence in patient care by remaining focused on the physician-patient relationship," concludes Dr. Rosenshein. "Our patients inspire us every day."

Excessive Triptans Not Recommended for Migraine Sufferers
Prophylactic Therapies May Bring Relief

CareFirst recently conducted a drug utilization review of patients suffering from migraine headaches. In the United States, approximately 18 percent of women and 6 percent of men suffer from migraine headaches; however, treatment regimens are not always managed effectively.[1,2]

Our drug utilization review was conducted in order to improve treatment planning for migraineurs by identifying and increasing our practitioners' awareness of patients receiving multiple prescriptions for triptans alone and/or in combination with Migranal. These patients are at increased risk of adverse effects, drug duplications/interactions and possible compliance or inappropriate treatment issues.

In addition, because recent research has indicated that prophylactic therapies may be effective in some migraine patients, we wished to review whether members were receiving any such therapy.

First, we reviewed our current eligible members' pharmacy claims data to identify patients who were prescribed excessive concomitant triptans and/or triptans with Migranal during the second quarter of 2000. Specifically, we identified patients who were given two or more prescriptions for Amerge, Imitrex, Maxalt, Maxalt-MLT, Migranal or Zomig concomitantly within that time frame.

We then reviewed the identified patients' pharmacy claims data from the same time frame for evidence of the following prophylactic drugs: Atenolol, Metoprolol, Nadolol, Propranolol, Verapamil, Diltiazem, Amitriptyline, Nortriptyline, Valproic acid, Depakote and Depakote ER (including both brand names and generics). None of the patients identified for excessive concomitant triptans and/or triptans with Migranal had any of these prophylactic drugs mentioned in their pharmacy profiles.

Evidence-based practice guidelines have suggested that select patients who meet established criteria could benefit from prophylactic therapies.[3,4] Although prophylaxis does not completely eliminate migraine attacks, it can ameliorate the severity and frequency of attacks and also can decrease personal disabilities. The use of prophylaxis also may decrease the risk of the "rebound headache" phenomenon. This is a well-described consequence of repeatedly treating headaches as acute events.[3,4]

Prophylactic regimens could potentially benefit patients who exhibit the following characteristics:[3,4]

• more than two attacks/month
• migraine attacks that are severe and significantly interfere with the patient's daily routines, despite acute treatment
• inadequate relief or serious adverse effects from acute treatment
• overuse of acute therapies

We recently sent CareFirst practitioners who have prescribed migraine-related drugs a summary of their patients' profiles as well as guidelines for migraine headache abortive therapies and prophylactics. The prophylaxis guidelines offer treatment indications and goals, medications and dosages (including adverse effects) and other recommendations. We hope you'll consider using these tools in your practice.

¹Hu HX, Markson LE, Lipton RB, Stewart WF, & Berger ML. Burden of Migraine in the US: Disability and Economic Costs. Arch Intern Med. 1999; 159:813-18

²Rapoport A, Lipton RB, Williams P, & Sawyer J. Cost - Effectiveness of Stratified Care in the Management of Migraine. 5th International Meeting. May 2000

³Evidence-Based Guidelines for Migraine Headache. 42nd Annual Scientific Meeting of the American Headache Society. 2000

⁴Capobianco DJ, Cheshire WP, & Campbell JK. An Overview of the Diagnosis and Pharmacologic Treatment of Migraine. Mayo Clin Proc. 1996; 71:1055-66

Management of Neurobehavioral Disorders by the Primary Care Practitioner

By Thomas L. Baumgardner, Ph.D., and Vincent P. Culotta, Ph.D., ABPN, Magellan Behavioral Health

The purpose of this article is to help primary care practitioners (PCPs) determine the role of neurology and neuropsychology in the diagnosis, management and treatment of neurobehavioral disorders.

Neurology is a branch of medicine that deals with the study and treatment of diseases of the nervous system. Following their training in general medicine, neurologists complete a specialized residency in disorders of the central and peripheral nervous system.

Neuropsychology is an applied science concerned with the behavioral expression of brain dysfunction. Neuropsychologists are doctoral-level psychologists with specialty training in the neurosciences.

Evaluative procedures
Neurologists and neuropsychologists utilize different evaluations. Understanding what each evaluation is designed to assess will help you determine which specialist might be right for your patient.

The neurological evaluation is a clinical exam designed to establish the localization of dysfunction in the nervous system. Anatomic localization is the foundation for both diagnosis and treatment. The neurological evaluation includes an assessment of the patient's:

• chief complaint
• medical history
• general physical health
• mental status
• cranial nerve function
• motor functions
• coordination
• gait and station
• sensory functions
• reflexes

The neuropsychological evaluation is designed to assess the cognitive and behavioral affects of known or suspected brain dysfunction and includes a clinical exam and administration of objective tests.

The neuropsychological evaluation includes an assessment of the patient's:

• chief complaint
• medical history
• intellectual ability
• academic skills
• sensory functions
• gross/fine motor skills
• attention/concentration
• visual/spatial perception
• memory and learning
• executive functions
• emotional/personality status
• psychosocial stressors

Choosing the right specialist
PCPs are often the first to recognize symptoms of a neurobehavioral disorder. Consider the following when referring to either a neurologist or a neuropsychologist.

• A neurologist typically focuses on the identification of pathology or disease and its medical management.
• A neuropsychologist is primarily concerned with the identification of functional deficits and strengths relevant to the development of specific behavioral interventions.
• Neurologists and neuropsychologists often work collaboratively in the diagnosis, treatment and management of brain-based disorders, and referrals are often reciprocal.

Other factors to consider are symptom presentation, acuity and chronicity.

Neurological consultation is indicated when there is acute onset of sensory disturbance, change in vision, motor impairment, headaches, mental status change and memory loss. These symptoms may indicate emergent medical conditions that require immediate attention.

Neuropsychological consultation is indicated in nonemergent, chronic or developmental symptom presentations and in differential diagnoses of physical vs. behavioral health disorders. Such consultation also helps determine the contribution of physical, psychological and environmental factors to a patient's symptoms.

Neuropsychological consultation also is indicated in the management and treatment of:

• neurological disorders such as dementia (Alzheimer's, Parkinson's, ALS), epilepsy, Tourette's syndrome and multiple sclerosis
• developmental disorders such as mental retardation, attention and learning disabilities, behavioral disorders and autism spectrum disorders
• acquired brain injury, cerebrovascular accidents, brain tumors and neurotoxin exposure
• systemic diseases such as IDDM, lupus, AIDS and Lyme disease

Many neurobehavioral disorders require collaborative evaluation and treatment by neurologists, neuropsychologists, psychiatrists and other health care providers. Neurological and neuropsychological consultation provides the PCP with important information that promotes positive patient outcomes.

Treating Cardiovascular Risk in Diabetics

By Simeon Margolis, M.D., Professor of Medicine and Biological Chemistry, Johns Hopkins University School of Medicine

Excellent control of blood glucose, careful attention to foot care and regular dilated eye exams are essential aspects of diabetic management - but they're not enough! To prolong the lives of our diabetic patients and decrease the number of their hospitalizations, we also must aggressively tackle all of the risk factors for cardiovascular disease.

About 75 percent of type 2 diabetics die of cardiovascular disease, and half of them have significant coronary artery disease at the time diabetes is diagnosed. Although some studies suggest that improved blood glucose control can delay or prevent cardiovascular events, the evidence is not very convincing. On the other hand, smoking cessation and lowering blood pressure and lipid levels clearly reduce the risk of coronary events and strokes in both diabetics and nondiabetics.

A 10-year follow-up of type 2 diabetics in the United Kingdom Prospective Diabetes Study (UKPDS) showed a remarkable fall in cardiovascular events, as well as a decline in the progression of retinopathy, in those who had what the authors referred to as "tight control" of their blood pressures. This "tight control" did not even approach the recommended levels of less than 130/80 mmHg. We must be more aggressive in our management of hypertension in diabetics in order to achieve even greater outcomes.

Although the UKPDS showed equal benefits from treatment with either an ACE inhibitor or a beta-blocker, ACE inhibitors are the drugs of choice in treating diabetes. ACE inhibitors slow the progression of diabetic nephropathy, another major risk factor for cardiovascular disease. In addition, the Heart Outcomes Prevention Evaluation (HOPE) study showed that the ACE inhibitor ramapril reduced cardiovascular deaths and all-cause mortality in diabetics with one additional cardiovascular risk factor, even if they were not hypertensive.

Long-term studies with pravastatin and simvastatin showed equal protection against coronary events for diabetics and nondiabetics, and the statins also reduce the incidence of strokes. Statins have protective effects in people who have impaired glucose tolerance as well as overt diabetes. Hypertriglyceridemia and low levels of HDL cholesterol are the most common lipid abnormalities in diabetes, and both the Helsinki Heart and the more recent Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial (VA/HIT) studies showed that raising HDL cholesterol levels with gemfibrozil significantly reduced the incidence of coronary events. LDL cholesterol levels are not particularly elevated in diabetes, but the small dense LDL common in diabetes is more atherogenic than garden variety LDL. Since studies have shown that type 2 diabetics with no history of a prior heart attack are as likely to die of a heart attack as nondiabetics with a previous infarction, the American Diabetes Association and the American Heart Association have recommended an LDL cholesterol target of less than 100 mg/dL in all patients with type 2 diabetes.

Control of blood glucose and lifestyle measures, such as weight loss and a low-fat diet, are the first steps in the management of lipid disorders in diabetes. However, an LDL cholesterol less than 100 mg/dL is often unattainable without the use of medications. These levels can often be achieved with one of the statins. Statins have benefits in addition to their effects on blood lipids. For example, in the Cholesterol and Recurrent Events (CARE) study, pravastatin reduced blood levels of C-reactive protein, thought to be a marker for arterial inflammation that promotes atherosclerosis. Some patients may need to add a fibrate for hypertriglyceridemia, niacin or a bile acid sequestrant if their HDL cholesterol is quite low.

Patients and physicians alike must be aware of the risk of severe myositis, rhabdomyolysis and renal failure when statins are combined with a fibrate. Niacin may raise glucose levels slightly, but can still be used in diabetic patients. A fibrate is the drug of choice when triglycerides are greater than 350 mg/dL; however, statins also can lower triglycerides significantly and raise HDL cholesterol by about 10 percent.

CareFirst's Pregnancy Case Management Offerings

In the Maryland region: Great Beginnings

CareFirst is excited about Great Beginnings, our new Case Management program for expectant mothers in our Maryland region. Great Beginnings was designed to supplement the prenatal care and education members receive from their providers. More than 700 members have enrolled in Great Beginnings since its introduction almost a year ago.

Great Beginnings has two levels of service available to CareFirst members in the Maryland region. When a member enrolls, the case manager completes a comprehensive assessment to determine which level of our program is best suited to the member's needs. CareFirst's obstetric (OB) case managers come from a variety of clinical backgrounds and have greater than 50 years of obstetric and case management experience combined. They provide your patient with a continuous support system during her pregnancy and also serve as a personal link between the member and her insurance company.

Level One of the Great Beginnings program is designed for those members at higher risk for complications during pregnancy. The case manager maintains frequent contact with the member and her providers to monitor the pregnancy, coordinate any services she may require and provide ongoing support. The case manager works with the physician to coordinate an effective treatment plan based on the individual needs of the member.

Members who are identified at a lower risk for complications are enrolled in Level Two of the Great Beginnings program. Members in Level Two receive a telephone call from a case manager during each trimester of pregnancy and after delivery. The case manager screens the member for additional risk factors as her pregnancy progresses and refers her to the Level One program as appropriate.

Our nurses and social workers connect members enrolled in both levels with community support and services for pregnant women. They offer valuable information about pregnancy during this stressful period.

The Great Beginnings program is available to all CareFirst members in the Maryland region who have a benefit for case management. You can refer your patients to our Great Beginnings program by calling 888-264-8648. Case managers are available to members and providers Monday through Friday between 8:30 a.m. and 5 p.m.

In the National Capital region
Our National Capital region members in high-risk pregnancies are eligible for care management as well, although their obstetrician will usually direct their care to appropriate specialists. For more information on high-risk pregnancy care management for our National Capital region members, call the number for precertification printed on the back of the member's ID card.

Palliative Care, Hospice and Other Alternatives for the Terminally Ill

When treating the terminally ill, providers need to be informed of the care alternatives and options available to the patient. Palliative care, hospice and pain management are some such care options that may be available to CareFirst, FreeState Health Plan and CapitalCare members.

Palliative care is generally offered at a time when a patient is still receiving active, curative treatment. The goal of palliative care is to keep the patient comfortable and pain-free while effectively enhancing the quality of life. When pain and symptoms are well-managed, the patient is able to focus on wellness and achieving maximum independence. Palliative care focuses not on death but on compassionate care for the living.

Hospice care should be discussed long before a patient enters the final phase of illness or when curative treatment ceases to be an alternative. Hospice recognizes dying as a natural process.

In the Maryland region
CareFirst offers palliative care and hospice services for its members residing in the Maryland region. Providers may contact CareFirst Case Management at 410-605-2623 or toll- free at 888-264-8648 to initiate this care for Maryland region indemnity members. These services also are available to FreeState Health Plan members. FreeState Health Plan Case Management is available at 410-605-2413 to coordinate these services for FreeState members.

A case manager is assigned to assist the physician, patient and family in making informed decisions. The case manager coordinates care according to the physician's treatment plan.

The case manager is part of a palliative care team that also includes the patient, the patient's physician, a home health care nurse and an aide, a medical social worker, and possibly dietitians, therapists and clergy. This team transitions the patient to hospice care when it is deemed appropriate by the patient, family and physician. At this stage, the team provides the patients with nonaggressive comfort measures focused on quality of life.

Inpatient hospice services may be necessary based on the family's needs and the physician's plan of care and can be set up by case management. Bereavement counseling for the family also is available under the hospice benefit to help the family address the complex issues of death and dying.

In the National Capital region
Terminally ill members in CareFirst's National Capital region have access to coordinated hospice and home health care as well as pain management services. Call the number for precertification printed on the back of the member's ID card. An associate care coordinator will direct your call to the appropriate case manager.

Our QI Program: Setting Goals for Improved Care and Service

CareFirst is committed to providing the highest quality of care and service to its members. The Plan's Quality Improvement (QI) Program strives to improve clinical care and administrative services in all areas of the delivery system.

Our QI Committees, working closely with community physicians, develop and implement the QI Program in a coordinated effort to promote preventive health care, manage chronic illnesses and continuously improve the care and services our members receive.

Annually, CareFirst implements a QI work plan that outlines specific clinical and service-related improvement activities using the National Committee for Quality Assurance (NCQA) Standards for Performance as a framework. Data are collected and analyzed for each activity throughout the year. Work groups then study barriers to improvement and develop targeted interventions to help us achieve our established goals. For example, in order to improve childhood immunization rates, a series of age-specific letters were developed to educate parents and remind them about the immunizations due for their child.

Categories of measures included in CareFirst's quality improvement plan include:

• use of preventive services
• compliance with clinical practice guidelines
• continuity and coordination of care in medical and behavioral health care
• effectiveness of disease management programs
• patient safety
• availability of practitioner and access to care
• potential overutilization or underutilization
• member and provider satisfaction

If you would like more information about the QI Program and how we're meeting our established QI Program goals, please call 410-528-7103 or 800-228-8161 in the Maryland region and 202-479-3516 in the National Capital region.

Varicella Reminder

In the United States, the incidence of varicella is highest between March and May. When assessing patient immunization status, children without a reliable history of chickenpox or with an uncertain history of immunization should be considered susceptible.

Varicella vaccination also should be considered for adolescents and adults at high risk of exposure, including:

• residents and staff of institutional settings, including college students, inmates and staff of correctional institutions
• military personnel
• teachers of young children
• day-care workers
• nonpregnant women of childbearing age
• international travelers
• health care workers
• susceptible family contacts of immunocompromised individuals

CareFirst Exceeds United Way Giving Goal

CareFirst and its associates donated more than $685,000 to the 2000 United Way campaign, exceeding the company goal by nearly $5,000. Over the last three years, CareFirst and its associates have contributed nearly $2 million to United Way for those in need in Maryland, Washington, D.C., and Virginia areas.

"I am pleased that associates have continued to demonstrate CareFirst's commitment to our community," said Eric Baugh, M.D., senior vice president, Medical Affairs and Network Management, and United Way 2000 campaign chair. "I am proud to be associated with such a community-oriented organization."

Philosophy of Care

We represent a philosophy of health care that emphasizes active partnerships between patients and their physicians. We believe that comprehensive health care is best provided by networks of health care professionals who are willing to be held accountable for the quality of their services and the satisfaction of their patients. We are committed to high standards of quality and professional ethics and to the principle that patients come first.

We believe that patients should have the right care, at the right time and in the right setting. This includes comprehensive care for acute and chronic illness, as well as preventive care - at home, at the doctor's office and in the hospital.

We believe that all health care professionals should be held accountable for the quality of the services they provide and for the satisfaction of their patients.

We believe that patients should have a choice within their health plans of physicians who meet high standards of professional training and experience, and that informed choice and the freedom to change physicians are essential to building active partnerships between patients and doctors.

We believe that health care decisions should be the shared responsibility of patients, their families and health care professionals, and we encourage physicians to share information with patients on their treatment options, medical conditions and health status.

We believe that consumers have a right to information about health plans and how they work. We believe that working with people to keep them healthy is as important as making them well.

We value prevention as a key component of comprehensive care, reducing the risks of illness and helping to treat small problems before they can become more severe.

We believe that access to affordable, comprehensive care gives consumers the value they expect and contributes to the peace of mind that is essential to good health.

Adapted from the American Association of Health Plans.

CareFirst's Mission

CareFirst shall be the leading regional health care company recognized for a comprehensive portfolio of high-quality, innovative products and administrative services. Our purpose is to provide the best value to our customers in partnership with the health care community and in an environment that promotes respect, fairness and opportunity for our associates.

CareFirst Physician Seminars 2001

CareFirst's Department of Disease Management and Health Promotion is pleased to offer the following Continuing Medical Education credit dinner seminars. Call Disease Management and Health Promotion at 410-528-7997 or 800-323-4472 for more information. You may register by e-mailing Sue Wingard, Health Promotion Coordinator, at wingard@annapolis.net. Please be sure to call/register as dates and locations are subject to change.

Congestive Heart Failure - Best Practices
This dinner seminar covers the underlying pathophysiology of heart failure and the significance of identifying and treating a reversible etiology, e.g., ischemia. You will learn to risk-stratify patients with heart failure based on clinical and laboratory findings. Discussion will include managing noncompliant and difficult-to-manage patients with heart failure. The pharmacology and use of medications to treat heart failure will be covered with emphasis on angiotensin enzyme inhibitors, combination therapy and third generation beta-blockers. This course will be offered:

Aug. 23	Baltimore
Oct. 11	Northern Virginia

Depression in Chronic Disease
This dinner seminar covers diagnosing depression in the primary care setting as well as recognizing co-morbid psychiatric disorders. Participants will be able to utilize a practical screen for uncovering depression or other co-morbid disorders. Treatment options for depression and anxiety will be discussed along with methods to improve patient compliance. This course will be offered:

May 30	Columbia, MD
Sept. 20	Baltimore
Oct. 18	Annapolis, MD
Nov. 15	Northern Virginia
Nov. 29	Rockville, MD
Dec. 6	Hunt Valley/Towson, MD

Diabetes & Cardiovascular Disease
This dinner seminar will discuss how to manage your type 2 diabetic patients with or without additional cardiovascular risk factors. It will cover the scientific evidence supporting careful glucose control and monitoring methods and will emphasize the necessity for control of dyslipidemias and concomitant hypertension. This seminar will be offered:

May 2	Northern Virginia
May 16	Baltimore
June 13	Rockville, MD
Sept. 6	Columbia, MD
Oct. 4	Hunt Valley/Towson, MD
Nov. 1	Pikesville, MD

What attendees have said about CareFirst's seminars
Yesterday's speaker was just excellent. He was very knowledgeable and entertaining. If he speaks again, on a different topic, I would love to come again.
- an R.N. from Baltimore

I just wanted you to know how wonderful the seminar was! Everything from the speaker to the dinner was fabulous. CareFirst did a magnificent job! Thank you for your hospitality and a delightful and educational evening.
- an M.D. from Prince George's County

 

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