Gold Choice PCMP IIA

Overview

Gold Choice is a partially capitated Medicaid Managed Care Program utilizing the Physician Case Management Model for ensuring access to primary care and specialty medical services. Approximately 450 Gold Choice members who receive care through 60 Erie County primary care sites are currently diagnosed with diabetes. Under this grant Gold Choice will improve diabetes management for these patients by using a “virtual” case management approach.

People with mental illness are especially vulnerable to complications from diabetes, as their condition often affects their ability to adhere to medication and self-care regimens. This project will establish diabetes registries, use nurse telephone case management and employ practice enhancement assistants to improve care for people with diabetes and mental illness.

One full-time and one part-time practice enhancement assistant will serve as temporary staff members and will be a shared resource for the 60 practices that provide care to Gold Choice members. Each practice enhancement assistant will help create diabetes registries and enter patient information into a computerized Diabetes Work Tool that includes check-boxes consistent with American Diabetes Association Guidelines. Based on that data, reports will be generated that inform nurses and physicians of recommendations for needed care and follow-up. Quarterly reports will be provided to physicians showing progress on practice change milestones. These reports will allow physicians to compare their performance to the other 59 participating practices. The assistants will also train office staff on using the computerized tool to allow for sustainability of the quality feedback reports over time.