Program rewards members for good diabetes care
Hospitalizations, emergency department visits drop
UCare's diabetes disease management program that rewards Medicare Advantage members for receiving their recommended examinations and tests has resulted in a decrease in hospitalization and emergency room visits.
From 2004 to 2006, hospital admission rates among UCare's members with diabetes dropped from 2.76% to 1.11%. Over the same period of time, emergency department visit rates for diabetic members dropped from 2.76% to 1.74%.
"We have an intensive education program to keep our members with diabetes informed about best practices in diabetes care and to encourage them to manage their disease. In addition to our efforts, our community has a lot of diabetes awareness activities, which may help influence the drop in hospital admissions and emergency room visits," says Jodie Milner, RN, BSN, manager of disease management.
Data from 2007 show that 31% of members who were stratified as "at risk," meaning they were missing one or more components of care, had improved to the point that they were reclassified as "low risk."
UCare modeled its Medicare Advantage diabetes program after a similar disease management program for Medicaid members with diabetes.
The health plan analyzes claims to identify members with diabetes and stratifies them as low risk or at risk. A member is considered low risk if he or she has had two hemoglobin A1c tests in a year, an annual cholesterol test, an annual dilated eye examination, an annual micro-albumin urine screening for kidney disease, and two well visits to a primary care physician or endocrinologist over the course of the year.
"Since most of the tests and examinations must be done once a year, we analyze data from members who have been enrolled with UCare for 12 continuous months," says Lorraine Cummings, LPN, disease management program coordinator.
All UCare members with diabetes receive educational brochures and newsletters about diabetes and recommended care as well as information about UCare's toll-free diabetes message line where they can ask non-urgent diabetes-related questions and receive a phone call from a nurse within two business days.
At-risk members also receive a customized diabetes care report that lists all of the laboratory tests and recommended visits along with the date of their most recent visit or screening. Copies of the report are sent to the members' primary care physicians.
The diabetes care report is accompanied by a voucher that the members get signed by their physicians and return to the health plan when they have completed all the tests and examinations. A completed voucher qualifies members for a gift card from Target.
Members also receive an additional voucher on which they fill in their hemoglobin A1c levels and their LDL cholesterol levels and return it for a Target gift card as well.
"The purpose of this voucher is to make members more aware of the laboratory tests they need and the necessity to get their laboratory values in control," Milner says.
Members who are up to date on all of their required examinations also receive a congratulatory letter and a reminder that they need to receive the same tests and exams over the next year. As an incentive for receiving the recommended care, the members receive a 100-minute phone card.
The disease management department receives utilization data on a daily basis that identify members with a primary diagnosis of diabetes who have had an inpatient stay or emergency department visit.
"We notify the patient's primary care provider of hospital stays or emergency room visits where diabetes is the primary diagnosis. Since some hospitals employ hospitalists, the primary care physician may not know that their patient has been hospitalized," Cummings says.
The health plan sends the physician a form with patient demographic information, information about the recent utilization, and a pharmacy profile that includes medication refills within the last two months.
"This enables the physician to determine if the member is filling his or her medication appropriately," she says.
The health plan is expanding its diabetes program to include an intensive case management initiative for high-risk members, says Tracy Fodstad, RN, PHN, BSN, complex care RN, who will be working with members who have been hospitalized or made an emergency department visit.
"We want to help the members overcome the barriers to getting their disease under control. It may be a case of helping the member identify a medical home and make regular visits to their primary care provider or coaching them on diet, exercise, or medication adherence," Fodstad says.
The health plan's case management department works with members who are seeing multiple physicians, take multiple medications, and have other complex needs.
The case managers work with them for a short period of time to coordinate their care, and then refer them back to the Medicare Advantage program.
The high-risk case manager program will target members who have been to the emergency department, had an inpatient stay, or whose laboratory values are outside normal parameters.
Some of the members are recommended to the program by physicians who feel that a patient needs more intense support to get his or her disease under control.
UCare's diabetes disease management program that rewards Medicare Advantage members for receiving their recommended examinations and tests has resulted in a decrease in hospitalization and emergency room visits.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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