Accreditation is next step for insurer’s DM programs
Members receive preventive health guidelines
When officials at Blue Care Network of Michigan heard about the National Committee for Quality Assurance (NCQA) disease management accreditation program, they were among the first to sign up.
In fact, the Southfield, MI-based insurer is one of 18 organizations and just one of two HMOs nationwide who are participating in the new program. Other participants include pharmaceutical manufacturers, a hospital system, and specialty disease management vendors.
"We pursued the first opportunity to make certain our programs are in line with national standards and expectations in the industry.
Participating in the accreditation process demonstrates we want to be recognized as one of the top disease management programs in the country. The endorsement of NCQA is the industry seal of approval. It will help us better promote our programs within our marketplace to our purchasers and consumers," says Janie Flemming, vice president of quality improvement programs.
The company began its comprehensive disease management program in early 1999 when the Blue Care Network was formed by four independently licensed HMOs. It is the HMO affiliate of Blue Cross Blue Shield of Michigan.
"Each of the regions had some disease management programs when we integrated. When we became one statewide organization, we took the best of all the regional programs and added to them," says Pam Reinert, MSN, director of quality management for Blue Care Network of Michigan.
The disease management programs for diabetes, asthma, and congestive heart failure are the longest running. The insurer added pregnancy management in 2000 and a depression management program in 2001.
There are about 40,000 members in all five programs out of a total of 530,000 members covered by the HMO.
The insurer is seeking accreditation for its asthma, congestive heart failure, and diabetes disease management programs.
NCQA released its final disease management program standards late last year. Blue Care Network of Michigan’s survey will be complete by the end of August.
"We have a top-notch disease management program. It supports the promise we have made in our vision and mission statement to maintain, improve, and promote health," Flemming says.
In addition to disease management programs for the at-risk population and case management for high-risk members, Blue Care Network offers a variety of programs to help members stay healthy. Among them are men’s and women’s health fairs that include screenings for cholesterol, bone density, glaucoma and vision acuity, and blood pressure as well as educational seminars and materials about exercise, diet, cancer, high blood pressure, and cholesterol.
Members receive preventive health guidelines as well as self-help guides for common health problems and discounts to community-based programs for smoking cessation, stress management, exercise and fitness, pregnancy, parenting, and CPR and first aid.
Blue Care Network of Michigan identifies members eligible for their disease management program through medical claims data, from medications prescribed for diseases covered in the program. Physicians refer members, and some choose to self-enroll.
When members enroll in a disease management program by Blue Care Network of Michigan, they receive a Personal Health Card that helps them take control of their health. The cards, which fit into a wallet, include the member’s identification number and spaces for health information such as medications they are taking, blood pressure readings and other vital signs, when they had their last screening examination, and a hotline number to call for information on their condition.
"We encourage the members to use the cards to help them better manage themselves. We encourage them to take them to the physicians so the physician can help them keep track of their health information," Reinert says.
The insurer began using the cards in late 2001.
The cards have been well received by members because they are easy to use, she adds. The members are given instructions on how to fill in the pre-printed card.
"We use similar cards in our health promotion programs to help our female population keep track of mammograms and pap smears, and we just moved the concepts onto our disease management program," Flemming says.
The company tracks its progress through clinical outcomes, a functional well-being survey, and an annual member and physician satisfaction survey.
Here are some tips from Flemming and Reinert on how to develop disease management programs in your company:
• Get early support from physicians and work to get physician buy-in, Reinert suggests.
"Without physician support, you lose a major link with the programs. Their involvement and their interventions are key to success," Flemming says.
• Look at the NCQA standards as a place to start, Reinert suggests.
• Take a team approach to managing chronic conditions.
"Disease management is an area that requires a lot of people working together as a team. This includes the case manager, the disease manager, the physician, pharmacy representatives, provider services, medical informatics staff, quality management staff, and customer service. All of these areas come together and work to improve the health of people with chronic diseases," Flemming adds.
• Be cautious about some of the claims disease management programs give you for a quick return on investment. Look carefully to see what is being measured and what the results show, Reinert cautions.
"If you have unrealistic expectations based on a literature review, you could be very disappointed in your results or question the value of the program," she adds.
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