For diabetics, compliance involves more than just knowing what to do

Award-winning program helps members overcome lifestyle issues

Coaching diabetics to make lifestyle changes, helping members overcome issues that affect their compliance, and offering classes to help patients cope with chronic disease have paid off for MVP Health Care’s award-winning Diabetes Care program.

The American Association of Health Plans and the Washington Business Group on Health recently recognized the program for clinical excellence. MVP was one of only two managed care organizations to be recognized in the National Exemplary Practice competition to identify successful approaches to improving the quality of health care.

Taking a creative approach to working with diabetics is the key to the success of the program, says Jerry Salkowe, MD, senior medical director of the Schenectady, NY, health plan.

The plan has seen significant impact on Health Plan Employer Data and Information Set (HEDIS)-related measures such as LDL cholesterol screening, eye examinations, and hemoglobin A1C blood tests.

“We’ve seen improvement over time, particularly in the high-risk group where we have found a dramatic difference in the measures for those who are actively involved in the program, Salkowe says.

The plan is in the process of completing an investment analysis, but preliminary results have shown that the diabetes program has had a return on investment that exceeds the cost of the program, he says.

The goal of the MVP Diabetes Care Program is to identify members with the illness, educate them, and encourage them to actively participate with their physicians in a disease management program that includes frequent blood sugar testing, eye examinations, and cholesterol testing.

MVP started its diabetes disease management program in 1997 and added the high-risk component in early 2001. Members in the high-risk group are assigned to nurse case managers who act as health coaches to help members achieve lifestyle changes.

The group decided to develop the plan in-house rather than hiring an outside vendor because it allows them to customize the program to meet the needs of its medical groups and members over a wide geographic area, Salkowe says.

Finding interventions that work with diabetics and health care providers often is a challenge for disease management programs, adds Gayle McLaughlin, RN, BSN, case manager for the high-risk diabetes program.

“Many of the standard approaches are dry, and it is hard to get people interested. We have different approaches in a form where people can get the message quickly and understand it quickly,” she says.

The nurse case managers in the high-risk diabetes management program call members regularly, help them set goals for changing their lifestyles, and help them deal with behavioral or family issues that may interfere with their compliance.

They may be referred to a therapist for individual counseling or to a program offered by MVP, the Personal Health Improvement Program (PHIP). MVP works with Mertech, a Norwell, MA, consulting firm, to deliver the PHIP program to MVP’s members. The program is designed to help patients cope with stress-induced physical symptoms and the pain caused by chronic diseases. It is a series of six weekly two-hour sessions designed to help the patient respond to everyday situations more effectively.

“The PHIP is based on the mind-body theory that mood and physical health are closely correlated. It helps patients reduce suffering and the symptoms of chronic illnesses by allowing them to become aware of how their bodily reactions are related to behavioral patterns and by teaching them new behaviors that will relieve their pain or discomfort,” Salkowe adds.

Physicians treating any MVP member with diabetes receive an informational summary twice a year with details on each patient in the diabetes management program.

The one-page summary, which the physician can insert into the patient chart, lists recommended treatment or testing for diabetics and checks off if the member has had the recommended tests.

The format for the report evolved over time with feedback from the physicians.

“The summary points out the red flags where the physician will want to work more closely with the members,” Salkowe says.

Members receive a companion document with information about their care and boxes to check off when the test is completed. The plan includes educational information so the members can understand why they need to have the tests done.

“We want them to take a more personal ownership of the management of their diabetes,” Salkowe says.

The plan sends members information about the importance of eye examinations and points out that they don’t need a referral and that the insurance will pick up the cost.

“It helps the members better understand their coverage. Some members tell us they haven’t gotten the eye examination because they thought they’d have to pay out of pocket,” Salkowe says.

The health plan sends the entire membership a quarterly newsletter that covers myriad health topics.

Diabetes patients receive a targeted newsletter at least twice a year with information such as the benefits of getting flu vaccine. The newsletters include interactive quizzes and information on how to get in touch with the diabetes disease management team.

Active participants in the high-risk program receive a one-year membership to the American Diabetes Association.

If the health plan’s data show that a member with diabetes hasn’t had an eye examination in the past year, the nurses call the member to remind him or her to have it done. In some cases, the member has had an exam but the health plan didn’t get a claim.

For more information on the PHIP, see Mertech’s web site, www.mertech.org/PHIP , or call (888) 794-7447.