Multilayered DM programs help members stay healthy

Population-based initiatives win accolades for health plan

A series of award-winning population-based and multilayered disease management programs has resulted in high member satisfaction ratings, improved HEDIS scores, and decreased utilization over time by members in the program for Anthem Blue Cross and Blue Shield plans in Indiana, Kentucky, and Ohio.

The program involves mailing materials at least quarterly to members whose claims data have indicated a chronic condition, mailed and telephoned reminders for members who have not received recommended tests and procedures, and referrals to case management for members who have a hospital admission or emergency department visit.

"We have found that layered interventions are very effective, particularly with patients who have had a high hospital readmission rate. Sending outreach reminders, postcards, and automated phone messages has generated statistically significant improvement in their health care behavior compared to those who get only a few notices a year," says Kim Byrwa, RN, CPHQ, director for health prevention and disease management for Anthem Blue Cross and Blue Shield plans in Ohio, Kentucky, and Indiana.

In 2004, Anthem Blue Cross and Blue Shield, a subsidiary of WellPoint Inc., received "Leadership in Healthcare" awards for diabetes and chronic obstructive pulmonary disease (COPD) programs from the Bio-Tech Medical Management Association, a Gold Award from the Disease Management Association of America, and an e-Value8 Health Plan Innovation award for asthma disease management from the National Coalition on Business Health.

The Anthem disease management initiatives focus on conditions that are most prevalent among the plan’s membership.

"Instead of focusing on small populations that may be high in cost, we tailored our program to conditions that are high in number," she says.

Multidisciplinary teams, led by a health care professional with expertise in that particular condition, designed the programs. The teams include representatives from marketing, legal, data, and case management. They studied all claims, utilization, and member survey data to design the programs and produce the educational materials that are mailed to members.

"The teams study the data and look for opportunities for us to provide education. We got some feedback that externally produced materials were too difficult for members to understand, or they weren’t culturally targeted, so we decided to produce our own materials," Byrwa says.

The materials feature health improvement information and tips such as reminding diabetics to take their shoes and socks off before the physician comes into the examination room, information on new technology and equipment, such as simpler glucose meters, new drugs for that particular condition, and information about the members’ benefits at Anthem Blue Cross and Blue Shield.

"The materials are constantly evolving, and we are constantly updating them. Many are similar because they are built upon nationally recommended guidelines, but we try to put different twists on the information to continue to support the recommendations and keep it interesting for the reader at the same time," she says.

The team plans the disease management publications a year in advance, creating different materials for each quarter. One of the most popular features is a custom-produced calendar the health plan sends members in its disease management programs each December. Custom calendars are developed around pregnancy, chronic obstructive pulmonary disease (COPD), asthma, and diabetes.

The diabetes calendar won the Gold Award from the Disease Management Association of American last year.

The calendars are filled with information designed to help members control their disease. For instance, the diabetes calendar has information on how to log low blood sugar and develop a graph, tips and tools to take to the physician, reminders of tests and procedures diabetics should receive, and recipes.

The diabetes calendar is available in Spanish.

"We include a survey in the diabetes calendar and receive a lot of positive feedback from customers after they receive the calendars. They report that they use them every day and share the information with their doctors," Byrwa says.

The health plan has found that materials produced in-house are more cost-effective and better meet the needs of Anthem’s own customers than if they purchased materials.

"We have almost half a million members in our disease management programs. Economies of scale make it economical for us to produce our own materials," she says.

Anthem’s disease management initiatives are population-based and are offered to every member who has at least one claim identified with a condition for which there is a disease management program.

Members identified from claims data get an introductory letter about their condition and the disease management program, followed by regular mailings of materials unless they opt out of the program.

"We mail the information to members at least quarterly. Every quarter, they get new and different information that helps them make lifestyle changes," Byrwa says.

The health plan analyzes claims data every month, picking out members who have not gotten the recommended care, such as eye examinations or cholesterol screenings. These are put into the second tier and receive additional information, such as reminder postcards, telephone calls, or voice messages related to what test or procedure they need to have.

Members who are in the disease management program and have a hospital or emergency department visit are referred to Anthem’s case management program.

Nurses conduct a telephone assessment and make follow-up calls to make sure the members are complying with their treatment plans.

"The members are still in the disease management program and receive all of the literature and other information. This just adds another level of assistance," Byrwa says.

Anthem has disease management programs for childhood and adult asthma, COPD, coronary artery disease, congestive heart failure, hypertension, depression, childhood and adult diabetes, chronic kidney disease, and normal and high-risk pregnancy.

The prevention portion of the program includes information on smoking cessation, sending mammogram and Pap smear reminders and outreach for members at risk for colorectal cancer, and reminders for members to obtain proper immunizations.

The health plan uses member surveys to find out how they can best meet their members’ needs.

For instance, one survey indicated that a number of members in the Appalachian region have a low literacy level. The teams have developed simple education materials geared to this audience that give them the same message as other materials but contain simpler language and more pictures.

When the plan analyzed data on immunizations for senior members, the study showed that African-American seniors with congestive heart failure (CHF) were receiving pneumonia and influenza vaccinations at much lower rates than other members in the CHF program.

The plan started outreach programs through community churches using pictures of African American patients and gearing the message toward "doing this for your loved one," based on research that showed this would be the best way to encourage action.

The health plan worked with Health Care Excel, the agency that has the Medicare contract in Kentucky and Indiana, to develop programs.

"Working with Health Care Excel, we went to churches across the Midwest and asked for help in displaying posters and giving out brochures to encourage these people to obtain immunizations," Byrwa says.

In Kentucky, where cardboard fans are staples in many churches, the health plan and Health Care Excel printed fans with a message reminding churchgoers to get their flu shots.