The goal of the coronary artery disease (CAD) program is to help members manage their condition and risk factors to prevent heart attacks, and unnecessary hospitalizations and improve their quality of life.
The criteria for identification:
One or more CAD or heart attack admission in the past 12 months
One or more CAD emergency department visit or heart attack in the past 12 months
CAD and low-density lipoprotein (LDL) cholesterol level greater than 100 mg/dL
CAD and diabetes with a hemoglobin A1c level greater than 9
Members are classified on the basis of their severity of illness and targeted for corresponding appropriate interventions. The program supports members by providing dedicated nursing staff, educational materials and medication compliance reinforcement.
Targeted interventions include but are not limited to:
High-performing network referrals and in-network referrals for primary care physicians and cardiac specialist facilities.
Consultation with a disease-management nurse to help the member progress through their goals and educate them about CAD in a series of calls over an average of three months, ensuring a commitment to long-term goals and better CAD management.
Treatment discharge planning and follow-up appointments after a heart attack.
Proper drug dose adjustment to manage blood pressure, LDL levels, A1c levels, as well as lab tests to ensure drug efficacy.
All patients receive personalized education from registered nurses. The content is based on American Heart Association/American College of Cardiology guidelines on medications, diet, exercise, lifestyle and coexisting diseases.
Print and Web-based educational materials (including a quarterly newsletter campaign) to support members in making lifestyle changes.
Depression screening
* Programs available according to employer policy (i.e., not all Administrative Services-Only clients purchase disease management services).
