Centegra Health & Wellness Network (CHWN) focuses on identifying gaps in the healthcare received by members with chronic conditions and pre-cursors to chronic conditions as well as preventive wellness care. The program focuses on preventing emergency department and hospital admissions by avoiding aggravation and deterioration of chronic conditions.
The Centegra Health & Wellness Network currently tracks the following measures:+ Childhood Immunizations
Childhood immunizations are responsible for the prevention and control of serious diseases. The goal of CHWN is to have all children receive the CDC recommended immunizations which are DTP, Polio, MMR, HIB, Hepatitis B, Hepatitis A, Chicken Pox, influenza, Pneumococcal and Rotavirus before two years of age. CHWN will work with providers and patients to ensure this is accomplished through reminders and outreach programs.
CHWN will work with discharge planners and the member to ensure that the patient follows up with his mental healthcare provider within seven days of his discharge from the hospital.
CHWN’s objective is to assist and educate patients with the management of their asthma through close monitoring, education, and pharmacologic treatments.
All members must have a completed Asthma Action Plan, an Asthma control assessment, smoking cessation counseling and educational programs and materials offered through the health system.
CHWN’s goal is to track and manage several performance measures, which include the following in order to manage these patients and prevent other illnesses that can sometimes be life-threatening. This program will focus on the members receiving timely physician visits and lab work as well as achieving controlled blood sugar (A1c) and bad cholesterol (LDL) levels.
- Blood Pressure Control
- Cholesterol Control
- Smoking Cessation
- Annual Screening for Microalbuminuria
- Annual Eye Exams
- Foot Care for People with High Risk Ulcers
- Influenza Vaccines
- HBA1c Control
- Depression Screening
CHWNs’ goal is to screen all members age 51-75 who are at risk.
CHWNs’ goal is to screen all members age 42-69 that are at risk.
CHWNs’ goal is to screen all members age 21-64 that are at risk.
This program focuses on members who have been identified with cardiovascular disease and should be monitored regularly to prevent progression of cardiac conditions. The program will monitor cholesterol (LDL), blood pressure, information about aspirin therapy and smoking cessation to reduce the risk of progression and improve the health of these members.
This program assesses cardiovascular disease prevention through a number of risk factors by randomly selecting members to ensure:
- They received information about aspirin therapy
- They received a blood pressure reading
- Their LDL-C was documented
- They are either a non-smoker or were advised to quit smoking
CHWN takes preventive medicine seriously. Therefore, this project tracks BMI percentiles and the rate of at least three primary care physician visits annually. The children should receive the following three services:
- Counseling for Physical Activity
- Counseling for Nutrition
Adult wellness is also very important. This project tracks BMI, smoking cessation, assessment of alcohol use, and at least three primary care visits annually.
The benefits of generic prescribing can produce not only a savings to the health plan but also to the patient. Generally speaking, most generic co-pays are much lower than the brand name co-payments. CHWN providers, when possible, will promote generic drug usage.
The Blue Star Medical Group/IPA Report recognizes HMO contracting medical groups/Independent Practice Associations (IPAs) that have documented high levels of performance in providing patient care. Annually, Blue Cross and Blue Shield of Illinois (BCBSIL) assesses medical group performance based upon national clinical practice and preventive care guidelines. Groups earn a “blue star” each time they meet the target care goal. Please visit the Blue Cross Blue Shield website for more information on this report.