Plan targets those at risk for cardiometabolic syndrome

Aim to get members on the path to healthier lifestyles

As part of its focus on prevention as a successful strategy to improve the quality and lower the cost of health care, Independence Blue Cross has launched a program targeting members who are at risk for cardiometabolic syndrome, a condition that may increase a person's chance of developing heart disease and diabetes.

The cardiometabolic risk management program is part of Independence Blue Cross' Connections Health Management Program.

"Chronic conditions, such as heart disease and diabetes, are very costly, not only to those who have them, but to all of us. These diseases may be preventable and are treatable. We strive to help our members get on the path to healthier lifestyles now, in the hopes that they will lessen their chances of developing, or worsening, serious and costly health conditions," says Esther Nash, MD, senior medical director for Independence Blue Cross.

The American Heart Association estimates that more than 50 million Americans have cardiometabolic syndrome.

"Cardiometabolic syndrome is not necessarily a disease or a condition but a constellation of risk factors that put people at risk for developing heart disease and Type 2 diabetes," says Kimberly Siejak, manager of population health and wellness for the Philadelphia-based health plan.

Risk factors that increase a person's overall chance of developing heart disease and diabetes include tobacco use, high body mass index, obesity, hypertension, high cholesterol, high levels of triglycerides, and elevated blood sugar levels, she adds.

"This program is different from a lot of disease management and health coaching programs because our goal is to prevent members from developing a disease. The program identifies people who may not have received a diagnosis of the disease but they are heading that way because of their lifestyle habits," she says.

The program provides education that is designed to help members avoid developing heart disease and diabetes.

The program identifies members at risk through medical and pharmacy claims data as well as the results of the health plan's health risk assessment.

The health plan uses a series of proprietary algorithms to stratify members and to identify those who are at highest risk.

For instance, to identify members with hypertension who are at risk, the health plan uses a combination of factors including hospital and emergency department visits and whether the member has filled his or her prescriptions.

The purpose of the program is to educate members about the symptoms of heart disease and diabetes and the behavior and lifestyle changes that may help prevent the diseases, Siejak says.

The program is staffed by health coaches who have an average of 10 to 15 years of clinical experience and are trained to help people manage their chronic conditions and assess readiness to change.

Low-risk members receive automated outreach calls that give them the option of contacting a health coach and enrolling in the program.

High-risk members receive telephone calls from health coaches who describe the program and invite them to participate.

The health coaches assess the members' readiness to change and work with them to develop strategies to modify their lifestyle.

Since many of the people who are at risk for developing metabolic syndrome lead sedentary lives, the coaches work with them to increase their physical activity.

They coach members to adopt healthy eating habits and to reduce their intake of fat.

"Once members engage with the health coach, they are invited to participate in behavioral change programs, depending on their type of risk. We have a program for tobacco cessation and an intensive weight management program," Siejak says.

The coaches help the members make lifestyle changes that can lower their risk. For instance, they may work with people with hypertension on cutting down on the salt in their diets and educate them on which foods to avoid.

Members who are working with the health coaches receive tool kits of exercises they need to complete between the health coach sessions.

For instance, in one exercise that is part of the smoking cessation program, the member keeps a log of triggers for smoking and in another is asked to tally the number of times he or she has tried to quit smoking in the past.

"The health coaches make follow-up calls and discuss the exercises with the member. This coordinated learning experience that combines what they are doing with the tool kit and the session with the health coach enables members to get a better handle on what motivates them to smoke and work with the coach to come up with a plan to change their behavior," she says.