Personal Care Management

An individual may be triggered for inclusion in the PCM program from a variety of sources, such as claims and pharmacy utilization data, referrals, health risk assessment (HRA) results, emergency room visits, and hospital admissions. A nurse reviews the available health information and determines if the individual is a potential participant. Eligible members are contacted by the nurse via an introductory letter and by phone. They may also receive e-mail communication if an e-mail address is available.

If a participant chooses to enroll in the program, he or she is assigned an experienced nurse who serves as a personal health coach. Participants work one-on-one with their nurse to establish specific, measurable goals for improving their health status. Through supportive, monthly phone calls, the nurse helps to motivate the participant to stick with the program and reach his or her goals; provides education about specific condition(s) and treatment options; recommends medical services to fill any potential gaps in care; and evaluates the participant’s progress based on measurable outcomes and self-reported data. There are no specific time limits on participation; the program will vary based on the individual needs of each participant.

Any information a participant discusses with his/her nurse health coach is confidential, and no personal health information is ever shared with an employer.