1. Mary Gardner, RN, MA, CCM, CDE Program Manager, High Risk Diabetes and COPD XLHealth Member Management Using The Med-eXpert System and Med-eMonitor Patient Appliance

2. 2 To provide information on the previous use and implementation of the Med-eXpert System, which links together patients using the Med eMonitor Patient Appliance, the ADT call center, and XLHealth Care Managers Objectives

3. The Med-eXpert System Confidential and Proprietary Care Givers ADT Monitoring Center Patients XLHealth Care Manager Med-eXpert™ Information Repository Patient Appliance Med-eMonitor™Med-eMonitor™ 3

4. 4 Diabetes Members with Heart Failure Voluntary agreement Provider contact approval Target Population

5. 5 Med eXpert System What Can It Do? Patient’s Med-eMonitor linked to Med-eXpert database, appliance sounds an alarm at the time of medication dosage or care plan activity (answer health query, self-care check, clinic visit) Records when the member takes their medications - it then sends the information to a secure site where a Care Manager will review it Sends automated alerts if the member is not taking their medications properly, experiences any side effects, or the responses indicate a potential health risk Information is confirmed with member and appropriate action is taken to facilitate medication adherence

6. 6 Medication - Guidelines Daily Reminder(s) to take medicines Confirm adherence or non-adherence Solicit reasons for non-adherence Monthly Contact to determine if have had: –Any medication changes Med-eXpert Care Plan Guidelines

7. 7 Intervention - Guidelines Weekly Reminder to test glucose, and enter levels into Med-eMonitor appliance Reminder to follow healthy meal plan Reminder to inspect feet and wear protective footwear Monthly Contact to determine if have had: –Any ER visits this month –Any hospitalization this month Med-eXpert Care Plan Guidelines (cont’d)

8. 8 Long-Term Goal: Member will take medications as prescribed by their provider to improve health outcomes and reduce health care costs Short-Term Goal: Member will adhere to their daily medication regimen as prescribed by their provider Medication Adherence Care Plan - Goals

9. 9 The Med-eXpert System enables Care Manager evaluation of factors affecting Medication and Care Plan Adherence: Medication adherence (e.g. side effects, out of meds, etc.) Financial issues Poor memory Complex dosing regimen Lack of understanding of therapeutic benefit Barriers to diabetes self-care Emotional issues Evaluates home support system Refer to appropriate resources to maintain safe medication administration Maintains provider collaboration Evaluates need for Social Services referral Medication/Care Plan Adherence Care Manager Interventions

10. 10 Long-Term Goal: Member will follow Diabetes care regimen prescribed by their provider Short-Term Goal: Member visits provider and specialty providers regularly Member verbalizes understanding of blood glucose targets Member knows the importance of following an individualized healthy meal plan Member practices healthy foot care Diabetes Care Plan - Goals

11. 11 Contacts provider for SBGM frequency, if unknown Contacts provider for referral to: Dietitian Diabetes Educator Social Services Specialty Providers –Endocrinologist, Wound Care Center, Podiatrist, Pedorthist, Vascular Specialist, Opthamologist Educate members to call their provider for: Significant changes in blood glucose results Episodes of hyper-or hypoglycemia symptoms Diabetes Care Plan Care Manager Interventions

12. 12 Long-Term Goal: Will perform daily foot exam Will wear diabetic shoes and inserts daily Podiatrist evaluation is complete and will seek a routine podiatry evaluation at least annually/ ≥ 4 times/year Verbalizes importance of emergent podiatrist appt if rest pain occurs Short-Term Goal: Verbalizes importance of seeking evaluation within 48 hours of observing foot problem Will perform daily foot exam Foot Exam Care Plan - Goals

13. 13 Assist member to: Find a Primary Care Physician, if needed Find a Podiatrist, if needed Find a Pedorthist, if needed Find an LEX vascular surgeon, if needed Foot Exam Care Plan Care Manager Interventions

14. 14 To evaluate: Member care needs –Regular provider and specialty visits, DME Healthcare compliance –Medication regimen, self glucose monitoring, healthy meal plan, healthy foot care Knowledge deficits To facilitate Care Manager interventions To Avoid Hospitalizations and ER Visits!! ER Visits and Admissions

15. 15 Thank You! Questions? Mary Gardner, RN, MA, CCM, CDE Program Manager, High Risk Diabetes and COPD XLHealth