Prevention program takes aim at osteoporosis

Case managers help prevent symptoms

When case managers at Geisinger Health Plan get in touch with members, screening for risk of osteoporosis is a routine part of the conversation.

"Our goal is to identify members who are at risk for osteoporosis before symptoms develop and help them prevent the disease. If members have been diagnosed with osteoporosis, we work with them to help them avoid having a fracture," says Sabrina Girolami, RN, CCM, MHSA, director of care coordination for the Danville, PA-based health plan, which is part of the Geisinger Health System.

The program was started in 2002 when Eric Newman, MD, a rheumatologist with Geisinger Health System asked the health plan to work with him on strategies for teaching physicians how to better diagnose and treat osteoporosis.

"On the health plan side, we took Dr. Newman's guidelines and developed key interventions. We want to make sure that all members who should be screened receive a diagnostic study and that they are educated on how to prevent the disease," Girolami says.

When members who have one of the health plan's targeted disease management conditions or are in a disease management or case management program that have risk factors for osteoporosis, the case manager who works with them educates them about osteoporosis, including giving them information on proper diet and supplements, and makes sure they are screened for the condition.

Geisinger Health Plan case managers have been trained in osteoporosis risk factors and on helping members receive timely diagnosis and treatment.

In the first year of the program, the proportion of members at moderate and high risk of osteoporosis who had bone mineral density tests increased from 51% to 67%. Within the first six months of the program, the percentage of members diagnosed with osteoporosis who were taking effective medications increased from 29% to 36%.

Case managers identify members with osteoporosis when they perform assessments following a hospitalization, during interventions for a condition that requires complex care, and when they work with members with targeted chronic conditions.

When the case managers follow up after members are hospitalized, they conduct an assessment that includes a portion on osteoporosis risk factors. The health plan also identifies members by analyzing claims and developing a list of individuals whose medical histories place them at risk. Case managers contact those members by telephone to provide them with key information about prevention and treatment.

They explain risk factors for osteoporosis, discuss ways to prevent the condition — such as increasing calcium intake, exercising regularly, and quitting smoking — and discuss the benefits of bone density testing and medications for osteoporosis.

Most of the people who are contacted about osteoporosis have other chronic conditions or have been hospitalized for another reason and are determined to be at risk. Some of the members are enrolled in case management strictly for care coordination for osteoporosis.

If the member does have risk factors, the case manager calls them back over the next few weeks and educates them on measures they should take to prevent osteoporosis. If they have been diagnosed with the disease, the case managers follow up to make sure they are being treated for the condition and work with them on compliance with the treatment plan.

"We work with the members on fall prevention in the home and suggest a whole suite of fall-prevention measures such as removing throw rugs and using night lights," she says. The case managers work with pharmaceutical assistant programs for members who need help paying for any medication, including osteoporosis medication.

Holistic approach to care

Geisinger Health Plan takes a holistic approach to care coordination. Every member who needs coordination is enrolled in case management and receives interventions based on what the case manager identifies as areas of needs.

The health plan provides disease management for members with asthma, heart failure, chronic obstructive pulmonary disease, coronary artery disease, chronic kidney disease, hypertension, and diabetes as well as working with members on tobacco cessation.

"We've had disease management programs for 12 years and recognized early on that we can't address one condition without addressing the other conditions. Case management is the umbrella and underneath the umbrella are all the needs that the patient may have. Nobody has just diabetes; they may need lipid management or have hypertension or heart failure," Girolami says. All of the case managers are cross-trained to help members learn to manage their chronic diseases as well as help members with complex medical conditions learn to navigate the health care system.

If someone is hospitalized with one of the conditions covered by the disease management or case management programs, a case manager contacts them within two days of discharge to make sure that recovery is going well at home and that the member has everything they need to comply with their treatment plan.