The Personal Care Management (PCM) program is an innovative way to manage members’ health. While health care in general has always been reactive —providing care after illness occurs — PCM is a uniquely proactive approach to identifying individuals who may show early symptoms of or be at risk for developing a serious and costly health issue, such as diabetes, heart disease, or hypertension. Program members receive personal encouragement and health education from a nurse to manage their conditions and stay as healthy as possible.

An individual may be triggered for inclusion in the PCM program from a variety of sources, such as claims and pharmacy 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.

MedCost periodically provides employers with a newsletter to share with their employees. To view the latest edition of the Personal Care Management Newsletter, click here.

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