ME-Cares Update

ME Cares

Nurse-Physician Care Support for
Cardiovascular Health in Maine

Update

The ME Cares program, nurse-physician care support for cardiovascular disease, has been adopted by 22 hospitals. Currently, approximately 800 patients are enrolled in the statewide program. Ten new hospitals will be initiated this fall in time to participate in the Medicare Coordinated Care Demonstration Project (MCCD). The MCCD project is scheduled to begin in the last quarter of 2001. Medical Care Development (MCD) continues to coordinate this statewide initiative, focusing on the following issues:

Reimbursement - As initial charitable funding winds down, it is imperative for the service to be sustained by private and public payers. At this time, CIGNA HealthCare and Harvard Pilgrim Health Care have agreed to reimburse this service and discussions are underway regarding the payment process. MCD is also having ongoing discussions with Anthem Blue Cross and Blue Shiled. Medicaid covers the service on a cost reimbursement basis; Medicare will cover the patient diagnoses of heart failure and acute myocardial infarction when the MCCD project begins.
Data Collection and Analysis - Preliminary data has been encouraging after one year of enrollment. A few examples include: a) significantly fewer patients reported having weight gain or shortness of breath at follow-up; b) of those with an NYHA class at baseline and follow-up, 74% either maintained or improved their NYHA class over time; and c) CHF patients had significantly higher SF-12 Physical health scores at follow-up compared to baseline.

The process by which data will be transferred to the Maine Health Information Center is currently being devised. Once care managers become proficient with the software system and the transfer process if fully implemented, data collection will increase. A major goal of the ME Cares program is statewide aggregate reporting on specific indicators with benchmarks for individual institutions.
Clinical Support - In March 2001 a day-long workshop was offered to the nurse care managers on Depression and Cardiac Disease. Dr. Stephen Katz and Dr. Richard Wexler gave presentations on the importance of this risk factor in its relation to heart disease. In September 2001 another workshop was held on Cardiac Rehabilitation. In addition, a workshop on Diabetes and Heart Disease is scheduled to take place in November. In addition to the workshops, the nurses continue to participate in monthly conference calls to trade experiences and issues. The Buzz, a monthly newsletter including clinical and programmatic updates, is distributed to all the care managers.
Consistency Across Program Sites - Working with direction provided by the ME Cares Steering Committee and several work groups, a set of explicit criteria, which must be met at all program sites, has been developed. A process of applying these criteria is currently under review. The goal of this effort is to assure that the quality of care support is consistently high across the state.
Physician Involvement - Another goal of the ME Cares program is to engage community and hospital medical leaders in the support of this valuable service. This leadership is critical in stimulating the involvement of primary care physicians and cardiologists for patient referrals and patient care coordination. Dr. Wexler is currently doing a survey of the level of physician involvement in all the current hospital programs. The results will be used for determining strategies and interventions with the goal of increasing this involvement.
Get With The Guidelines - The American Heart Association is launching a national program called Get With The Guidelines; an attempt to promote the increased use of both primary and secondary prevention guidelines in hospitals and physician practice settings. The ME Cares Coalition is working closely with AHA to integrate these two initiatives in Maine hospitals.
Contracting - All ME Cares providers currently use the CMS^â information system developed by Pfizer Health Solutions. For many provider organizations, a single contract has been negotiated in an effort to simplify the contracting process and help control administrative costs.

For more information about the ME Cares program, please contact either: Claudette, RN, 207-622-7566, ext. 260 (cbean@mcd.org) or Richard Wexler, MD, at 207-622-7566, ext. 226.