New program attacks diabetes from all angles

Employees at all risk stages can be targeted

PCS Health Systems, a Scottsdale, AZ-based subsidiary of Pharmaceutical giant Eli Lilly and Co. of Indianapolis, has drawn on its own corporate resources and the expertise of strategic partners to launch a disease prevention and management program targeting diabetes.

Part of PCS’ "Performance Health" disease prevention and management offerings, the diabetes program was officially launched in June 1996. The three main players in the program are PCS; Control Diabetes Services, a Dallas-based company with a proven track record in helping employees manage their diabetes; and The Right Track, a Seattle-based joint venture of PCS and the Group Health Cooperative of Puget Sound, Seattle.

Program already a success

The Right Track program, which began pilot site programs in January 1996, has already helped employees reduce overall blood sugar levels and improve their knowledge about diabetes management.

Diabetes was a logical choice for the PCS roster of disease management programs, says Kevin Hanna, MBA, BSPharm, vice president of corporate finance for clinical products at PCS.

"Diabetes is a major area of chronic disease across the U.S. population," he says. "Depending on the numbers you read, although only 3% of the population has diabetes, I’ve seen statistics indicating it accounts for as much as 12% to 15% of all medical expenses.

Also, if you look at co-morbidities — such as cardiac and renal problems — some people say as much as 25% to 30% of all medical costs are directly or indirectly related to diabetes." Hanna notes that diabetes, asthma, and heart failure are the three biggest health concerns for employers because of the high costs associated with treatment and their devastating impact on employee health.

Research has shown that tight control of diabetes can dramatically reduce co-morbidity. According to the DCCT (Diabetes Control and Complications Trial) — a 10-year clinical study conducted by the Institute of Diabetes & Digestive & Kidney Diseases — it was shown that for every 10% reduction in Glycohemoglobin, damage to the body is reduced by 50%.1

More benefits to the management program

A diabetes management program offers two additional benefits, says Hanna. "Anything that instills a skill set and discipline in employees that enables them to manage a chronic disease makes them feel better about themselves and more productive," he says. "In addition, such a program communicates to the employee that ‘My employer cares about me.’"

The PCS program has three basic components, each catering to specific needs of employees and specific levels of risk:

Healthy Results: Designed for employees in the early stages of diabetes whose health has not significantly been affected. Its components include:

— a program announcement and risk- assessment instrument;

— a video called "Living Well with Diabetes";

— an interactive brochure series based on standards of care practice;

— a patient newsletter;

— a nutrition CD-ROM, with information on meal planning.

The Right Track: For employees whose health has experienced significant erosion. It is a comprehensive telephonic and mail-based patient education and behavior modification program. It includes:

— an initial introductory letter to the employee and physician;

— an assessment questionnaire, addressing issues such as frequency of blood glucose self-testing, medications, foot and eye care, diet, exercise, and smoking; a summary is sent to the employee’s physician;

— a series of phone calls (about 45 minutes in length) from a certified diabetes educator;

— a telephone post-test;

— "Personal change." A 12-month follow-up period with one phone call per month.

Control Diabetes Services: For patients at higher risk for complications. It is a face-to-face patient education and behavior modification program, in which the employee makes personal visits to a CDS storefront location for classes. It includes:

— patient assessment;

— counseling with certified diabetes educators, registered nurses and registered dietitians;

— scheduled follow-up visits;

— phone support.

Diabetic employees identified

Once an employer has signed on for the Performance Health diabetes program, PCS will review either pharmacy claims data (if the company is already using PCS for its managed pharmaceutical care) or raw medical claims data to identify, among other things, those employees who are either on insulin or some other diabetes medication or who have had diabetes-related emergency room visits. "Once we’ve identified them, we can drop them into the appropriate program," Hanna explains.

The component of the three-part program with the longest track record is The Right Track, and Russ Hanscomb, RN, MHA, program development specialist, is pleased with the results to date. "We launched the program in January 1996 with Texas Instruments [Dallas] and US West Communications [a Denver-based telephone company], and we’ve worked with close to 100 employees," he reports. "On the average, their glycohemoglobin dropped from 8.77 to 7.95; there was a significant increase in foot exams being conducted by their providers; and their scores on the knowledge test went up from 83% to 91%."

"We have about 1.4 million lives currently enrolled, and it’s growing rapidly," adds Hanna. "We’re seeing response rates of 49% on our patient feedback forms, so we know people are opening the envelopes. And we’re running between 85% and 92% positive on the quality and usefulness of the information, with a 1% dissatisfaction rate."

[Editor’s Note: For more information on the PCS diabetes management program, contact: Kevin Hanna, PCS Health Systems, 9501 E. Shea Blvd., Scottsdale, AZ 85260-6719. Telephone: (800) 223-7745. Internet: http://www.pchs.com.]

Reference

1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Eng J of Med. 1993; 329:977-986.