DM programs help to reduce hospitilizations
July 1, 2002
DM programs help to reduce hospitilizations
Programs continue to be refined, enhanced
A team approach to managing chronic diseases and conditions has proved beneficial for Blue Care Network of Michigan.
Blue Care Network developed its five disease management programs in-house with the assistance of outside resources and continues to refine and enhance the programs.
For instance, this year, the company contracted with Alere Medical, a Reno, NV-based medical technology and services program for its congestive heart failure monitoring program.
Members in the program receive electronic scales that hook into a telephone line and transmit the patient’s weight and answers to a series of questions to a nurse from Alere who takes action in contacting the primary care physician if warranted.
"So far, the results have been very positive. We started in late 2001, and we have already shown improvement in reducing hospitalization and maintaining patients’ weight and health status in the home," says Pam Reinert, MSN, director of quality management for Blue Care Network of Michigan.
All of Blue Care Network’s disease management programs have the same basic framework and design and include member education components, data, and tools for the physician to use in managing members with chronic illness, monitoring the medication and treatment plan, and measuring the clinical, utilization, and cost outcomes of interventions taken.
The insurer strives for early identification of members in a number of ways, including claims analysis, physician referral, and member self-enrollment. New members age 50 and older are asked to fill out a health risk assessment as a way to identify people who may be eligible for disease management early on.
When a member is identified, the company sends the member an introductory package and notifies the primary care physician that the member has been identified for the program. Members are given the opportunity to choose not to participate in the program.
"If someone opts out of the program, we take them out and notify their physician they will not be receiving the information. Otherwise, everyone receives the same interventions and the same educational information as designed in our programs," Reinert says.
All participants in the disease management programs are asked to fill out a well-being survey, tailored to their disease and condition, at the time they enter the program and at the end of six months.
Among the questions on the survey are: Do you feel better now than six months ago? Do you have more energy than six months ago? How many days of work or school did you miss because of your condition? The insurer sends physicians information from their patient data registry and sends them regular reminders of the need for preventive screening.
The disease management team mails reminder notices to the members periodically. For instance, near the holidays, the members in the diabetes disease management program may receive a reminder about dietary cautions during the holidays. When it’s time for flu shots, all members get a notice. Smokers receive information on smoking cessation programs.
"We try to interweave all of the programs to make them relevant," says Janie Flemming, vice president of quality improvement programs.
Members in the highest-risk populations, those who are admitted to the hospital or visit the emergency room, are turned over to case management for more comprehensive and intensive case management. The case managers work with the physicians and contact the patients regularly to check on their progress and see if they have additional needs for home health care or other services.
Blue Care Network has documented consistent improvement on the outcome measures for each program since their existence. In 2002, new programs scheduled for implementation are Migraine Headache Management, Low Back Pain Management, and Diabetic Management for Children.
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