Diabetes program combines disease management, case management
Hospitalizations per thousand members drop by 19%
A diabetes management program that combines education, disease management, and case management has resulted in a 19% reduction in hospital admissions per thousand among members with diabetes for Blue Care Network of Michigan.
Other outcomes in the program for 2003 include a 16% reduction in hospital admissions per thousand for patients with myocardial infarction-related events and a 13% increase in members’ glycemic control.
The Southfield, MI-based health plan’s diabetes program was recognized with an honorable mention by the American Health Insurance Plans Foundation’s Excellence in Health Care Awards Dinner.
The program is overseen by a multidisciplinary team that includes a physician, RN-disease management specialists, a health educator, a pharmacologist, and representatives from case management, quality management, medical informatics, network performance improvement, and corporate communications.
"When an intervention is designed, it has been touched by all these professional areas," says Christine Karl, RN, manager of disease management at Blue Care Network of Michigan.
The program includes mailing regular educational materials to all members, disease management interventions for selected members at moderate risk for complications, and case management for members who are at high risk for complications.
The plan sends all members’ primary care physicians information about nationally recognized standards of care for people with diabetes and member-specific data about tests and procedures.
Other components of the program include formal diabetes education in geographic locations that are convenient to their members with diabetes, and a web site with interactive tools for people with diabetes and links to the American Diabetes Association and other organizations that provide help.
"We attribute the decline in hospitalizations to a health management and educational approach. We concentrate on what the physician needs to know about the latest in best practices for effective diabetes care and what the patient needs to know to communicate with the physician and be enabled to provide self-management," Karl explains.
The program has two individual components — one for those older than age 18 and one for those 18 and younger.
Members are selected based on a series of criteria including diagnostic codes and medication codes. In addition, physicians, case managers, and other Blue Cross Blue Shield of Michigan intake departments may refer. Some members are identified through a health risk appraisal; others refer themselves to the program.
When members are identified as eligible for the program, they are sent a welcome packet and an overview educating them about what it means to have diabetes.
The program is an opt-out program, but few members choose not to participate.
"We enjoy a 99% participation rate. Our members with diabetes are very happy to receive the materials and support," Karl reports.
Members in the program are stratified into five categories according to a health risk appraisal that includes their age, sex, demographics, and claims history.
Members in all five categories receive mailed interventions that include a newsletter and reminders for recommended tests and procedures.
A disease management program specialist, who is an RN, determines the specific needs of all members in categories 2, 3, and 4 and calls selected members.
For instance, if the members haven’t been getting regular hemoglobin A1C tests, they might get an extra reminder.
Members who are at Category 5 are referred to case management and work with a case manager to develop an individual plan.
All members can call a toll-free number and talk to a disease management nurse if they feel that they need extra help or have questions.
For instance, they may have problems getting their glucose meter and supplies, and the disease management nurse can assist them in overcoming these barriers.
The health plan produces a newsletter for all program participants with news about diabetes, diabetes treatments, and how the Blue Cross Network can help them get the services they need. The newsletters are mailed at least three times a year. Disease management specialists and health educators produce most of the literature in-house.
The four-page newsletter, mailed out three times a year, includes information about Blue Care Network’s web site, case management, and health education services and articles that change with each issue.
"We rotate the topics and have a list of topics that we cover every year, such as benefits, eye exams, hemoglobin A1C tests, and cholesterol management," Karl says.
The articles include basic education about diabetes, how to recognize symptoms, what lifestyle habits can contribute to complications, and self-monitoring techniques such as how to make healthful choices during the holidays.
They include tips on glucose monitoring, reminders to have a health care practitioner check out their feet, and explanations of the importance of blood tests, retinal exams, and blood pressure monitoring.
"We recommend that the members have a well visit to the doctor at least annually to make sure things are still on track and emphasize the importance of keeping regularly scheduled appointments, even if they are feeling good," Karl adds.
The plan sends members information on how to recognize psychosocial problems, such as depression, which often accompanies chronic illness.
"We help them learn to cope in social situations, such as how to eat correctly during a fancy Thanksgiving meal," Karl reports.
The team often uses input from members as an inspiration for the content of the newsletter. For instance, a member might call the disease management nurse saying he or she is confused about flu vaccine, suggesting a topic for the upcoming newsletter. "If a member is concerned about a particular topic, the nurse compiles quick information and sends it to them but also remembers it for the next newsletter," she says.
At least twice a year, the plan identifies members who have not had hemoglobin A1C or cholesterol screenings or other recommended procedures.
Members who have not complied with the recommended treatment receive automated voice reminders and post cards.
In addition, the health plan sends a Health eBlue CD to the members’ primary care physician, with information about the members in their practice who are part of the diabetes disease management program. The CD ROM includes details on each patient, including how many office visits or emergency department visits he or she has had, the status of his or her hemoglobin A1C and cholesterol screenings, and information about other recommended screenings such as Pap tests for women.
"The beauty of it is that not only can they read what we know about the patient, but they can also upload data," Karl says.
For instance, if the claims data show that a member hasn’t had a hemoglobin A1C screening and the physician knows otherwise, he or she can update the CD ROM.
The physicians receive a bimonthly newsletter with current information about diabetes care. When there are any changes to treatment guidelines, the health plan notifies the physicians immediately. "We maintain our own clinical practice guidelines for them to follow and update them regularly," Karl says.
The health plan’s case managers are RNs who monitor and track clinical outcomes and communicate with the members by telephone.
During the initial telephone call, the case manager confirms the diagnosis, makes sure the member understands his or her condition, and assesses for comorbid conditions such as coronary disease, vascular disease, or depression.
They assess the members’ functional status and how it may interfere with activities of daily living. The telephoned questionnaire also includes assessments of psychological and family support needs, a medication review, and tobacco and alcohol use. Members also may take the plan’s health risk assessment on-line.
They work with the members and primary care physicians to coordinate the services that each member needs. For instance, if a member needs an eye exam but doesn’t have an ophthalmologist, the case manager helps find one.
The nurses collaborate with the members and physicians to create treatment plans. The plans include member-specific goals with short-term goals. For instance, if a member needs to lose 100 pounds, the specific goal may be to lose 2 pounds in a month. "The member and case manager decide together on short-term goals that could lead to an overall goal," Karl explains.
After the treatment plan is developed, the case manager monitors how effective the interventions and recommendations have been.
The case managers send out condition-specific information that supports the goals and can refer members to other programs, such as Blue Care Network’s obesity management program.
A diabetes management program that combines education, disease management, and case management has resulted in a 19% reduction in hospital admissions per thousand among members with diabetes for Blue Care Network of Michigan.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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