Patient education, physician leadership and integrated care delivery distinguish the disease management program at Great-West Healthcare as the best for a PPO, says the Disease Management Association of America.
Great-West, a Denver-based employee benefits provider that specializes in self-funded plans, was recognized in late October by DMAA as one of 11 award-winning programs that have raised the bar in disease management performance.
"The integration story is that it's integrated in all products, across all programs," says Terry Fouts, M.D., chief medical officer for Great-West. "We don't chop people up by organ system or where they happen to be in the care continuum."
Great-West offers disease management programs in asthma, diabetes, oncology, cardiac conditions, and neonatology.
It plans to begin pain and depression management programs in 2004.
Disease management is incorporated into all of its insurance products as an opt-in program, with about 70,000 current members and around 180,000 over three years, Fouts says.
Participation has led to an increase in appropriate physician office visits, pharmacy usage and decreased hospital stays for program participants, he says.
Disease management at Great-West has three levels of physician leadership, with Fouts carrying the ultimate responsibility for the success of the programs. J. Dean Greeson, M.D., is the clinical liaison, as well as medical director for the southeast region for Great-West.
Each program also has one or two physician champions who work with a nurse champion to assess clinical content and ensure smooth integration.
Fouts emphasizes that the plan is not using disease management to take the place of the physician treating patients.
"We're trying to support the member between visits and we involve the physician on all these care paths," he says.