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MainCare Care Management Program

jessievenegas Jessie Venegas — 11/01/2009

This project continues a demonstration to develop managed care program for dually eligible Medicare and Medicaid beneficiaries. The purpose of the demonstration is, co-funded by the Robert Wood Johnson Foundation, to enhance the clinical and administrative coordination of primary, acute, and long term care services for adults and elderly Medicaid beneficiaries. MaineNET is an entirely voluntary program with primary and acute services for all eligible beneficiaries managed through a contracting primary physician. Medicare and Medicaid claims information is used to monitor program impact. Utilization and cost data is shared with primary physicians to facilitate patient education as well as improve service arrangements. The program manages all diseases of its members, with the most common being: Asthma, Cardiovascular diseases, Diabetes, Depression, and Lower Back Pain and benefits patients with: • multiple chronic conditions, • multiple medications, • in need of self-management education, • with special needs • whose medical care is complicated by depression • with multiple emergency room or inpatient admissions and • in need coordination of multiple services for their medical needs

Diabetes, Asthma, Fragility, pluripathology/polipathology and/or complex chronic diseases, All, Other

Goals Prevention:
Funding for detection programs , Promotes adecuate understanding levels on the community about the importance of prevention , Focuses on social inequalities
Goals Detection:
Promotes early intervention through primary health care measures , Shows new evidence on the importance of early detection, including guidelines of effective practices , Advances public education on the importance of early detection
Goals Treatment:
Develop basic elements for an integrated health system , Provides support health policies to facilitate the planning and integration at locally and regionally , Strengthens cooperative local groups to provide integral services , Improving access to health services across the entire spectrum, from prevention to treatment , It facilitates the management by processes , Emphasizes the care of pluri-pathological and fragile patients
Goals self-management:
Refocuses the health system to support self-management , Promotes patient involvement in planning services , Improving support services with an emphasis on peer support, the disabled and carers , Allows home care , Allows remote support to patients and their carers from health professionals








University of Southern Maine
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