Personal Care Management is a new, innovative type of case management. While health care in general has always been reactive—providing care after illness occurs, Personal Care Management is uniquely proactive. It focuses attention and resources on those with health issues which, if addressed early, may not develop into more serious and costly conditions.

Personal Care Management provides mentoring and monitoring for those who have previously “fallen through the cracks” because their conditions were not serious enough to require traditional case management or disease management. Now, Personal Care Management fills this gap in the continuum of care. With Personal Care Management, the needs of “at-risk” patients can now be appropriately addressed.

Claims and pharmacy data provide the “referral triggers” that proactively identify at-risk patients for Personal Care Management. Internal referrals by MedCost nurses can also identify these patients. Participants are contacted, assessed, and monitored for care needs and educational deficits. Program enrollees receive customized education about their health condition, resulting in better self-management and increased compliance with treatment and medication regimens. Patients are monitored regularly, enabling the early interventions that facilitate optimal health status. With regular monitoring, nurses recognize the “red flags” that lead to a proactive transition to traditional case management, when needed. This is another way Personal Care Management helps circumvent potentially high costs and adverse events.