Texas plan finds success through patient contact
Administrators at CIGNA Healthcare of South Texas in Houston aren’t shy about talking about money and the potential savings that can result from prevention of complications. "Our goal is to keep people healthy. And when they are healthy, they are going to need less services," says John Seidenfeld, MD, MSHA, FACP, vice president and medical director of CIGNA HealthCare of South Texas.
"I sure hope it will save money," he says. "As people are more healthy and take less time off work and have less of the end-stage problems, we’re going to be a lot better off and they will be, too."
So CIGNA has begun to pursue the 3% of its 225,000-member organization who are diabetics and account for approximately 10% of the managed care plan’s costs. The effort began with identifying those individuals from pharmacy and claims information.
In 1996, CIGNA began sending monthly mailings to physicians and patients reminding them which tests had or had not been performed and when eye exams, urine protein exams, and follow-ups with primary care physicians were due.
"It is individualized, and we found it wasn’t duplicating something the doctor was already doing," Seidenfeld says. "Actually we’ve had pretty good feedback on this."
Now CIGNA has contracted with Diabetes Treatment Centers of America to further identify diabetic members in its population and intervene for higher levels of screenings. Included on CIGNA’s test menu: retinal screens and quarterly visits to the primary care physicians which include blood pressure, urine protein, lipids, HbA1c, and foot exams.
The numbers show it was working even before the intensive intervention began earlier this year. Retinal screens are up to 38% of the plan’s diabetic membership.
"It’s still low on the national scale, but it’s good in South Texas. We started out at 29% in 1996," Seidenfeld says.
CIGNA is aiming for three to four doctor office visits a year, and Seidenfeld says about 30% of CIGNA’s diabetics are meeting that goal, compared to about 20% before the plan began sending reminders.
Best of all, Seidenfeld says, in 1996, 33% of diabetics had no visits at all, and now only about 8% are not seeing a doctor at all. He expects the 1998 numbers will be even better.
For information, contact: John Seidenfeld, CIGNA HealthCare of South Texas, (713) 552-7616.
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