Incentives work in disease management initiatives 

Program saves $1.6 million in three years 

When new members enroll in one of Blue Cross and Blue Shield of Oklahoma’s (BCBSOK) health promotion programs, they receive free equipment to help them monitor their chronic disease.

For instance, members in the diabetes health promotion program receive a free glucose meter to enable them to check their blood sugar regularly. Patients with congestive heart failure get bathroom scales to encourage daily weight monitoring. The plan provides peak flow meters for people in the asthma disease management program.

BCBSOK will give away pedometers to encourage an exercise regime for members in the new coronary artery disease program, which went live in April.

Other components of the program include disease case management for high-risk members, classroom education for some diagnoses, coordination with members’ physicians, and regular educational materials for members in all risk categories.

Preventive screenings increase 

"We have found that our initiatives make a difference financially, and from a clinical perspective," adds Elaine Olzawski, RN, MPH, manager of operations for the medical affairs department.

The initiatives must be working. Over a three-year period, the health plan saved nearly $1.6 million in cost of care for people in the health promotion programs. The figure includes total medical costs, not just disease-related costs. The health plan has seen an increase in quarterly hemoglobin A1C checks, foot checks, and eye exams for diabetics and in other recommended preventive care measures for members with other diagnoses.

"We’re starting to see some improvement in control of blood sugar. It’s not statistically significant yet, but there is some movement," she says.

Potential members are identified through claims and pharmacy data as well as referrals from providers, members, and the company’s customer service department.

The health plan’s utilization management software sets up an automatic referral process if anyone is admitted to the hospital with asthma, diabetes, congestive heart failure, or coronary artery disease.

"Chances are we already know about that person, but it may be a new member who wasn’t in the system the last time we ran the data, or it may be someone who is newly diagnosed. An automatic feed from our utilization management program helps ensure that nobody falls through the cracks," she says.

The health promotion staff at BCBSOK are specially trained nurse case managers who typically coordinate the care for about 500 members, Olzawski says.

When members are identified for a disease management program, they are stratified into risk categories. Low-risk members receive the health incentive tool and are mailed educational materials.

The nurse case managers contact the high-risk members by telephone at intervals that depend on the severity of their disease. They reinforce the educational materials, answer members’ questions, and coordinate with members’ physicians.

Members with diabetes who are at risk are offered classroom education taught at a diabetes education center certified by the American Diabetes Association. The class focuses on living a full life with diabetes, including menu selection when dining out, adjusting medications, and self-monitoring techniques.

The classes may be individual for Type 1 diabetics and in a group setting for Type 2 members.

The health plan sends reminders to diabetics to schedule screenings such as foot exams, hemoglobin A1C screenings, and eye examinations.

The disease management nurses contact the high-risk members once a quarter to reinforce the educational program.