DM program cuts overall health care costs by 10%
DM program cuts overall health care costs by 10%
Plan focuses on pre-diabetics who are at risk
By engaging members who are at high risk for diabetes and getting them into a health management program before the disease creates problems, Blue Cross of California has reduced medical cost for members in its diabetes disease management program by 10% overall.
"By the time someone has symptoms, they already have the disease state and are much further along than we would like them to be. At Blue Cross of California, we're tying to identify the pre-diabetics and engage them," says Anthony Nguyen, MD, MBA, FACHE, medical director for the health plan, a subsidiary of WellPoint Inc. with headquarters in Thousand Oaks, CA.
The company's disease management programs are instituted through the Health Management Corporation, a wholly owned subsidiary of WellPoint.
The health plan has seen a return on investment of $2.48 for every $1 spent on its disease management programs overall.
The diabetes program has shown a 4% reduction in the cost treatment at inpatient facilities, a 6% drop in outpatient costs, a 20% reduction in emergency department visits, and 10% overall savings in medical costs.
The health plans uses health care informatics, including claims data, pharmacy data, and laboratory results, to identify people who are at high risk, such as people whose laboratory values show that they have borderline diabetes and high cholesterol.
To keep a handle on people who may be in danger of an exacerbation, the health plan stratifies members on a monthly basis.
"A member may not be at high risk today; but in a few months, something could happen that puts them at risk. We don't wait until the end of the year to stratify the members," Nguyen says.
Members who have been identified as being at high risk for diabetes and its complications receive outreach calls from behaviorists, people with medical backgrounds who are trained in behavior modification techniques.
"The behaviorists try to sell the program to the member, telling them that their employer has purchased the benefit and how it can help them. They also engage in behavior modification during the initial call, which makes our program unique. It doesn't matter how many people you identify for a program; if you can't get an individual to change his or her behavior, the end results will never be achieved," Nguyen says.
By using behaviorists to make the initial phone calls, the health plan has achieved an 83% enrollment rate in all five disease states.
"Unless you can sell and engage a member, you aren't going to be able to get them to go along with the rest of the program," Nguyen says.
The behaviorists talk about how diabetes is a silent killer, and that by the time the member notices eye problems or difficulty in urinating, it's late in the game.
"We don't use scare tactics but use an educational engagement process to help the member see the benefits of the program his or her employer has paid for," he says.
The behaviorists turn the member over to disease management nurses with training in diabetes management.
The members receive phone calls with help tailored to their individual needs and a frequency that is based on their stratification.
"We individualize the program as much as possible because each member is a unique person with unique needs," he says.
For instance, one diabetic may have foot problems and need to quit smoking, while another may have difficulty administering daily insulin shots.
Disease management with a team approach
At Blue Cross of California, disease management is a team approach, with the disease management nurse serving as quarterback for the team.
"The nurses can call in a dietitian for help with meal planning or a social worker who can suggest community resources. They keep the patient's physician in the loop as part of the team," he says.
Once a member has agreed to join the program, his or her primary care physician is alerted and receives regular updates from the disease management team.
The disease managers help the members gradually meet their health care goals and work with them depending on the disease state and the level of engagement the member wants.
For instance, if a member has just been told he needs to quit smoking, lose weight, take insulin, and get his blood pressure under control, he is likely to be overwhelmed by the magnitude of the changes he needs to make.
"We encourage them to take small steps that can add up over time," Nguyen says.
The disease management nurses tailor their interventions to the way the member wants to communicate. Some prefer e-mail. Other would rather receive a phone call.
Members who have moderate risk receive a telephone call, an introductory letter, and a disease management kit that they are encouraged to share with family members.
"We know that the diabetic's spouse may be cooking for them, and we want to encourage other family members to get their parent to follow the diet or take walks," Nguyen says.
In addition to printed materials that are mailed to them, members have access to diabetes management information on the health plan's web site and may call the health plan's nurse advice line 24 hours a day.
The health plan uses a multilingual staff to communicate with the members.
"We have staff who understand the cultures and languages of our members and who are sensitive to cultural beliefs that could affect their compliance with the treatment plan," Nguyen says.
The disease management nurses and the staff for the nurse advice line work out of call centers located in several parts of the country. The call center staff have the ability to warm-transfer members to someone at another center if that is what it takes to find a nurse who speaks the member's language.
"Each person is different, and many of our members are from different cultures. It is helpful to have a nurse who speaks in their individual dialect and who understands their culture," he says.
By engaging members who are at high risk for diabetes and getting them into a health management program before the disease creates problems, Blue Cross of California has reduced medical cost for members in its diabetes disease management program by 10% overall.Subscribe Now for Access
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