Issues and Trends in Chronic Care

Overcoming Language & Cultural Barriers to Care Focusing on Special Needs Providing Personalized Online Health Information Advancing the Quality of Care for End-Stage Renal Disease Improving Options of End-of-Life Care Using Information Technology to Drive Health Care Improvements

 Overcoming Language & Cultural

Current Issues & Trends in Chronic Care

Barriers to Care

help breakdown cultural barriers that may prevent members from obtaining effective care. Promotora the eyes of the physician, the ears of the nurse and the heart of the clinic. - also acts as an interpreter during visits to health and social service practitioners.

- The promotora talks with the patients

Overcoming Language & Cultural Barriers to Care

outside of the medical setting, and she takes time to listen to their concerns. By maintaining ongoing, personal contact with members, the promotora builds strong bonds of trust that help motivate the patients in following treatment plans.

Focusing on Special Needs

provide extra help for beneficiaries who have chronic conditions or have low incomes. Special Needs Plans (SNPs) are Medicare Advantage plans that are permitted to provide coverage designed specifically to beneficiaries with chronic conditions or beneficiaries who are in nursing homes. SNP status makes it possible for health plans to offer benefits aimed at meeting extensive medical, social service, behavioral health, and in some cases, financial needs.

 HealthNow a customized web-based resource for health information. HealthNow creates a web page with information tailored to his or her health conditions and preferences. Based on analysis, HealthNow may include, for example, information on preventive care recommended for people with diabetes, strategies for addressing seasonal allergies, and or reminders to have a flu shot.

Providing Personalized Online Health Information

Advancing the Quality of Care for End-Stage Renal Disease

Nurse care managers set up the full range of

medical, social, and behavioral health services that members need. For example, they may arrange for home health care, physical therapy, or occupational therapy. They also help members in finding dialysis centers convenient to their homes. Care managers communicate regularly with members physicians about their health status, and in conversations with members, they seek to reinforce physicians care plans. For example, they help patients choose healthy foods, understands how to take their medications correctly.

Improving Options of End-of-Life Care

Include coordinating medical and social services; offering information about treatment options and helping members make informed decision about care; helping members to understand their medications, manage pain and cope up with side effects. Interdisciplinary palliative care team consisting of a nurse, social worker, and physician assessed patients physical, medical, psychological, social and spiritual needs. These team were expanded to include pharmacist, chaplains or spiritual counselors, dieticians & bereavement coordinators as needed.

Using Information Technology to Drive Health Care Improvements Health plans are using the power of information technology to closely track the health status of members with chronic conditions. Based on ongoing electronic monitoring, data collection and analysis, health plan staff are able to take prompt action to improve patients care and well-being.

Thank You & God Bless!!!