Program stratifies patients into severity-based zones
February 1, 2002 2 minutes read
Program stratifies patients into severity-based zones
Results after interventions are dramatic
By concentrating on patients who need interventions and gearing the individual interventions to their specific needs, Denver-based One Health Plan’s CareResults disease management program in Denver has achieved dramatic results.
For instance, about 70% of diabetics who joined the program were not testing their hemoglobin A1c levels when the program began. Now more than 50% are being tested, a 21% improvement in the number of diabetics being tested on a regular basis.
At the beginning of the program, 42% of the total respondents did not know their potential asthma triggers. Of the high- and medium-risk patients who completed the three-month follow-up survey, only 24% did not know their triggers.
Among participants who completed the baseline and three-month surveys, there was a 96% increase in the use of peak flow meters.
"It helps them identify when they need to go to the doctor," says Wally Gomaa, MBA, MHA, president of One Health Plan. Gomaa attributes savings in the cardiac care program ($1,700 a year for participants vs. nonparticipants) to the use of low-dose aspirin. Participants reported a 27% increase in the use of low-dose aspirin. Members who participate are stratified into Red, Yellow, and Green Zone cases based on their answers to an interactive questionnaire. "What we have done is identify those people where we can make a difference in their lives. They have the greatest risk for costly care," Gomaa says.
Red Zone members are those who are not knowledgeable about their condition, who have high self-reported severity issues, are not performing adequate self-management, and are likely to become patients who need high-cost interventions. Yellow Zone members are at moderate risk and receive literature, test kits, and are asked to take follow-up questionnaires.
Green Zone members are at low risk and do not receive any active follow-up during the initial year, but are re-targeted the next year.
The program concentrates on patients whose risk factors can be improved, not just those with severe cases of their disease. "For instance, in diabetes management, we don’t target individuals who have serious cases of diabetes and are eating right and exercising. There is nothing more we can do for them. We target those whose diseases could become serious," Gomaa says.
At the beginning of the program, 6% of participants were in the Red Zone category. After 12 months, the percentage had dropped to 0.25%. "This means the members have more knowledge about managing their disease because they have made lifestyle changes, and we are seeing that they know what they should do to manage their conditions. Their risk for high cost care has dropped," Gomaa says.
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