ME-Cares (Nurse-Physician Care Support)

Executive Summary

ME Cares is a coalition of 30 Maine hospitals that offer community-based care support (disease management) programs for patients with heart failure (HF) and coronary heart disease (CHD).  Work on the program began in 1998, building on the belief that:

	The care of ambulatory patients with chronic illness is aided by building systems to extend the scope and reach of traditional, office-based care.
	Physician support of clinical programs increases the likelihood that programs will be effective.
	Physician support is more apt to occur when programs originate in local, provider organizations and when programs apply to patients regardless of their payer status.

Further impetus for the coalition came from the expectation that community-based programs will encourage community resource development benefiting patients with disease and individuals without known disease.

To advance these ideas, stakeholders gathered (including representatives from physician and hospital organizations, health plans, Medicaid, and the QIO) and key program elements were defined, modeled after a successful program in Farmington, Maine.  Subsequently, as a coalition of interested providers emerged, a governing structure was established, a license to use a common information system with embedded clinical content (CMS® Pfizer Health Solutions) was obtained, common outcome measures were adopted by all participating provider organizations, and a credentialing process was implemented.

The basic care support intervention involves outgoing phone calls to enrolled patients from nurses employed by participating hospitals.  Guided by the care plan developed in conjunction with the supervising physician (usually a PCP) and the clinical content in the information system, the major interventions are education and support for behavioral change.  Patients learn about their disease, their symptoms, and their treatment.  They learn to monitor their condition including when and whom to call for help.  They are both challenged and supported in their effort to change unhealthy behaviors that are known risk factors for disease progression (smoking, sedentary life styles, unhealthy diets).  National treatment guidelines are followed and variances are discussed in a collegial manner with the treating physician.

Working under the auspices of the Maine Cardiovascular Health Council, Medical Care Development (MCD) facilitates the project. The Maine Health Information Center manages data transfer (protecting patient and provider confidentiality) and Pfizer Health Solutions provides data analysis.  To encourage consistency across provider sites, the ME Cares Steering Committee sets policy and has credentialed the participating sites using an explicit criteria set.  Consistency is also fostered as each site uses a common information system with clinical content (CMS®), reports program outcomes using the same measurement set, and participates in shared learning sessions.

Patient participation requires a physician order.  Over 2,000 patients have enrolled in the program to date.  Typically, patients with CHD participate for one year while those with HF remain enrolled for a variable time depending on their progress.

Program-wide results show improvement in a wide array of clinical measures when baseline and follow-up values are compared.  Heart failure patients (a progressive illness) show symptomatic improvement, better self-monitoring, improved mental health scores (SF 12), and medication use conforming more closely to current clinical guidelines.  Similarly, CHD patients have improved mental and physical health scores (SF12), better adherence to clinical guidelines, a reduction in their cholesterol levels (total and LDL), and improved control of diabetes when present.  Individual hospitals receive reports allowing comparison of their results to the program-wide results. 

In order for the ME Cares program to continue, a sustainable financial model must be developed, reimbursing hospitals and supervising physicians for the services provided.  Progress in that direction is well underway.  In January 2001 the Center for Medicare and Medicaid Services awarded MCD and the ME Cares program a grant to serve as one of sixteen demonstration sites as they evaluate the effectiveness of “coordinated care.”  As participants in the project, hospitals receive $124/enrollee/month (inclusive of monitored exercise) and supervising physicians receive $20/enrollee/month.  As of October 1, 2002, CIGNA HealthCare is also reimbursing hospitals and physicians for services provided to patients with heart failure.  Medicaid offers reimbursement to hospitals on a cost basis.

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For More Information:

For more information on ME-Cares, please contact Claudette Bean, RN, at 207-622-7566, ext. 260 (cbean@mcd.org)  or Richard Wexler, MD, at 207-622-7566, ext. 226 (rwexler@mcd.org). 

Medical Care Development, Inc., 11 Parkwood Drive, Augusta, Maine  04330