Medical Management

Medical Management is the highest priority of the RDN. A Medical Management Committee Plan was created in 1998 and has been revised and updated annually. Progress has been remarkable and goals have been attained as a result of concentrated efforts by interdisciplinary work groups. Concentration was on process in 1999 and guideline and measurement in 2000-2001.

Initiatives are identified through data analysis, need of an individual member organization and /or committee need. Once a need is identified, a work group is initiated and given a charge that spells out the parameters of the initiative. A physician and staff leader are appointed and a committee is selected from Networks of the member organizations. The process enhances buy in from the region during the development and through the implementation process.

The process is unique as each work group is required to build a "Tool Kit" that can be used by providers in the implementation stage. It includes a variety of resources such as educational materials, literature searches on the topic, registries of patients falling into protocol, charting materials, resource materials for patients, educational speakers and best practices. A Network provider has the option of what tools to use based on what fits best into his/her practice. Once a protocol is initiated, it is monitored through the Medical Management committee. Examples of the work include:

Diabetes The diabetes guideline was completed in 2000. The Diabetes Registry was a key tool that was developed post implementation.

Adult Asthma The guideline was completed in 2000 and an educational program regarding the asthma guideline was completed at the PHO level in 2001. An Asthma Registry has been added to the tool kit.

Depression After review it was determined that an RDN Guideline would not be developed because of a lack of evidence-based studies. A toolkit has been distributed with tools to identify depression in patients and suggested treatments.

Pediatric Immunizations All PHO's collaborated with the state to measure immunizations through CASA. There is a current collaborative effort to have everyone involved in the MICR program. Muskegon is the most developed organization working with the MICR program and immunization education. This is being used as a best practice for replication in the other PHO's.

Beta Blocker Post MI A guideline was developed and approved by the Board in 2001. Education took place at each PHO. Measurement will take place in 2002 with baseline evaluation and goal determination to follow.

Cancer Screening/Adult HME An adult HME reference sheet was completed with cancer screening information included in 2001. The references for this document were Blue Care Network, Priority Health and Care Choices. Due to the lack of an "evidence-based" model this did not become a guideline and hence the term "reference." Each PHO sent positive feedback to the Medical Management Committee and the reference sheets were distributed through the PHO's.

Pediatric HME A Pediatric HME reference sheet was completed using multiple sources including state, regulatory agencies, medical societies, and HMO's. As was true with the Adult HME reference sheet, the Pediatric HME did not become a guideline. The Pediatric Reference sheet was approved by the individual PHO's.

CHF The CHF work group was established and guideline was produced in 2002. The work group has used an integrated system approach to this guideline by addressing ambulatory, diagnostic, emergent, and inpatient needs for the CHF patient.

Pediatric Asthma This guideline was developed in 2001 and completed and implemented in 2002.

The Medical Management Committee is currently working on a variety of issues including the pharmacy program with BCBS, case management profiles for each organization, credentialing and review and development of reports that are clinically valuable to providers of care. Recently we have initiated a subcommittee to develop an educational strategy for the Network.

The RDN has experienced improvement in our measured outcomes. These outcomes are available upon request.

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