Coaching, counseling help promote compliance

Program targets high-risk members

A woman with diabetes who has struggled with compliance for years before getting her disease under control told Gayle McLaughlin, RN, BSN, “Every time I start to go off track, I keep hearing your voice in my head.”

The woman is just one of the success stories for MVP Health Care’s high-risk diabetes program.

That particular patient had lost her job just after her husband was diagnosed with cancer, recalls McLaughlin, case manager for the high-risk diabetes program.

“She had so many things going on in her life that she couldn’t handle any of them. She had an insulin pump and didn’t test it properly or give herself insulin prior to meals,” McLaughlin explains.

The case manager finally got the woman to realize that she was sabotaging her own health and agree to go to counseling.

She’s started counting carbohydrates and giving herself insulin as directed.

Behavioral health issues often get in the way of compliance with treatment regimes, but once they get help addressing them, patients are more likely to comply, McLaughlin points out.

“Once people can handle the stresses in their lives, they are more interested in their diabetes and their general health. Then we can see good outcomes, better control, and they follow through on their treatment plan,” she adds.

For instance, one patient who had seasonal depression was compliant part of the time, but when he became depressed, he ignored his treatment regime.

McLaughlin helped him get counseling and attend MVP’s Personal Health Improvement Program, a series of classes that teaches participants how to address stress, how to handle relationships, better eating behaviors, and other techniques for having a healthier lifestyle.

After a few weeks, the man’s condition improved so much he was able to get off one oral medication and his hemoglobin A1C level dropped to six.

“He was able to sustain good eating habits and had a very good outcome,” McLaughlin says.

MVP Health Care, based in Schenectady, NY, identifies people in the high-risk population through a health risk appraisal, physician referrals, and claims patterns.

The program is primarily a health-coaching type of program, McLaughlin says.

When a member is referred to the program, his or her nurse case manager does a telephone assessment of his or her educational needs and how well or how poorly he or she is managing their diabetes.

“We find out from members if there are family issues or behavioral health issues that could be a problem and, if so, we refer them to our behavioral health department,” McLaughlin says.

She helps members set goals for what they want to accomplish, whether it’s self-managing the diabetes or other lifestyle changes and helps them identify barriers to accomplishing the goals.

She is in touch with the members as often as every week and as infrequently as every month.

“I make follow-up calls to check in with the members, learn how they are doing, and discuss what is and what isn’t working. I do whatever I can to help the member move forward,” explains McLaughlin.

Since the program started, McLaughlin has seen drops in members’ A1C levels. A number of members have quit smoking and enrolled in exercise programs.

The nurse case managers call the physician occasionally if there are concerns and to obtain lab results so they can keep tabs on the members’ A1C and LDL cholesterol levels, according to Gail Sapone, RN, MS, health promotions manager.

Blood sugar testing

A key to successful diabetes management is regular tests of blood sugar levels.

Diabetics know that they should test their blood sugar level, but they may need a jump-start to get them to do it regularly, McLaughlin says.

“Many of them are in some level of denial. They don’t want to see the results because they know it is going to be bad. I tell them that if they don’t know what their blood sugars are, they don’t know if the diabetes is going well or not going well,” she says.

McLaughlin starts out getting members to agree to test their blood sugar at least once a day. If they won’t test but once, she gets them to stagger the tests — before breakfast one day, after breakfast the next day, then in the afternoon, and before bedtime.

“If they stagger the testing, we can get a picture of what is going on, and they aren’t totally overwhelmed by having to test numerous times a day,” she adds.

Sometimes, the staggered tests pique the members’ curiosity and they start testing more frequently to see how what they are eating affects the level. “When members need to test their blood sugar on a regular basis, I talk to them quite often and find out what is getting in the way. We work together to help them be successful,” she adds.

The health plan has two nurse case managers dedicated to the program. The plan aims to have each case manager work with 100-120 members at a time.

“We are constantly trying to find people for the program. Some people agree to be in the program but we can never reach them again. It is a struggle to keep them engaged,” McLaughlin says.

Members typically are in the high-risk program from six to 12 months and are discharged when they reach their goals, Sapone adds.

“If a member has made behavioral changes and is successfully keeping their A1C and LDL cholesterol levels down and has lost weight, we pull back with the health coaching and talk to the member about taking control on his own,” McLaughlin says.

She encourages members to call if they need help in sustaining their goals or have a concern or a question.