Evercare Health Plans

(Operating in 37 States)

Purpose:

To overcome fragmentation and improve health outcomes - including fewer emergency treatments and hospitalizations - by providing coordinated, individualized health care and well-being services to those with complex needs

Target Population:

Evercare members with special needs, including chronic illness or disability, living independently or in long-term care facilities

Program Goals:

• To improve health outcomes by coordinating medical care for people in nursing homes or living independently, who have chronic illnesses or disabilities
• To reduce hospital admissions and emergency department visits
• To focus on individual needs of patients and to provide personalized care management

Years in Operation:

1987 – present

Results:

Evercare has resulted in greater access to medical and nonmedical services, better health outcomes, and lower costs to Medicare and Medicaid. The Evercare approach has:

• Reduced hospitalizations for nursing home residents by 45 percent, and emergency room trips by 50 percent.
• Achieved high satisfaction rates among enrollees and families. A 2005 survey of enrollees in Evercare's community Medicaid plans showed 91 percent of enrollees and responsible parties were satisfied; 95 percent intended to continue with Evercare.
• Saved the State of Texas approximately $123 million in Harris County alone between February 2000 and January 2002 through the STAR+PLUS program

Funding:

Evercare is offered by United Healthcare and funded through Medicaid, Medicare and privatepay premiums.

Key Partners:

Providers; community health services; long-term care facilities; patients; patient families; Medicare; Medicaid

 

What Works and Why:

The integrated care team includes patients' families and community services as well as providers and long-term care facilities. Care is often provided on-site to avoid the difficulties and potential trauma to the patient associated with transporting patients from long-term care facilities to appointments for care. Having a clinical care manager helps communication among providers, facilitates obtaining recommended preventive care and any follow-up required, and assists in identifying potential problems early enough to allow for proactive steps to avoid serious complications. Having ready access to electronic health records for each patient facilitates coordination significantly.

Structure and Operations:

Evercare provides a variety of health plans for people with long-term or advanced illnesses. For enrollees, a nurse practitioner or care manager serves at the center of an integrated care team that includes the enrollee's physicians, family members, and nursing home staff or representatives from community service agencies.

Nurse practitioners and care managers work with the enrollee and their integrated care team to develop and manage personalized care plans that increase preventive care and the early detection of potential problems. Evercare developed a proprietary electronic health record system that includes electronic health records for each patient to facilitate coordination, track patient health, and evaluate patient needs.

Nurse practitioners and care managers coordinate multiple services; facilitate better communication among physicians, institutions, patients and their families; and help ensure effective integration of treatments.

Barriers to Success:

Care coordination depends upon providers having the resources and willingness to share information and collaborate. Changes in public program reimbursement may make offering new services and sustaining them difficult.

More Information:

http://www.evercarehealthplans.com

Download:

Download this program information in PDF format.