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Diabetes Member and Physician Interventions

The physician and patient can collaborate together, to take proactive steps to address and manage diabetes.

Interventions Based on Stratification

The HealthPlus Risk Stratification method is based on condition eligibility criteria, clinical and financial data, predictive modeling, and self-reported information. Stratification is a dynamic process and the stratification level can change as the member’s condition changes.

Eligible members are categorized into four levels of risk, where Intense represents the highest level of risk and Low indicates the lowest level of risk.

Member Interventions

HealthPlus provides the following interventions and resources to members, caregivers, or guarians to address Diabetes issues.The diabetes patient, parent or guardian may utilize the following interventions to address diabetes.

Intervention

Risk Level

 

Low

Moderate

High

Intense

Introductory letter and program packet informing how member was identified, how to use the services and how to opt out

Once initially

Once initially

Once initially

Once initially

Welcome call

Once initially

Once initially

Once initially

Once initially

Health Appraisal (includes depression screen)

Every two years

Every two years

Every two years

Every two years

Disease-specific newsletter (includes lifestyle issues, smoking cessation, etc.).

2x/year

2x/year

2x/year

2x/year

Educational materials

4-6x /year

4-6x /year

4-6x /year

4-6x /year

Special equipment (glucometer)

As needed

As needed

As needed

As needed

Web-based support and education (Krames Online/disease-specific videos)

Available

Available

Available

Available

Seminars (e.g., nutrition)

2x /year

2x /year

2x /year

2x /year

Tobacco cessation

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Weight management

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Behavioral health referral

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Offered - opt in basis

Member satisfaction survey

Annually

Annually

Annually

Annually

General standards of care reminder message (automated phone/mail)

Annually

Annually

Annually

Annually

Missed services reminders (automated phone/mail)

3x/year

3x/year

3x/year

3x/year

Polypharmacy review

 

Monthly

Monthly

Monthly

Care Counseling RN monitoring and assessment calls (includes SOC & PHQ2)

 

 

Monthly

 

Case Management discharge telephonic assessment for standards of care compliance after 2 or more inpatient admission for Diabetes in the past 30 days within the past 182 days

 

 

 

Each Discharge

  • Assessment/enrollment for case management after current admission for condition within the last 30 days or

 

 

 

 

Each Discharge

  • Predictive Modeling Score.
 

 

 

 

Monthly

 
 

Physician/Provider Support

The physician may utilize the following interventions to address diabetes.

Intervention

Frequency

Program fax-back form to get provider input on High stratification members and the appropriateness for monthly RN care counseling calls

At least annually

Provider manual introduction to programs

Updated annually

Notification of disease management program information in Provider Plus newsletter

Annually

Educational tools for offices (e.g., personal diabetes care record, diabetic retinal exam report sheets)

As needed

Exception list of primary and secondary services

Monthly

Patient Chronic Care Profile  identifying potential missed services and co-morbid conditions

Semi-annually

HEDIS® compliance reports with academic detailing (with benchmark and peer comparative analysis) to PCPs

At least annually

Lunch and Learn by RN disease management coordinators or Certified Diabetes Educator (CDE)

2-4x/year

Educational review on pharmacy utilization for practitioners with members with poly-pharmacy Moderate strata (all members eligible)

Monthly

Nurse review of records for individualized performance feedback and education for physicians with members in Moderate-High-Intensive risk stratification

As needed

Office staff educational forums provided by HealthPlus

At least annually

Office Care Improvement

  • Audit, feedback
  • Tools, materials
  • Office staff education
 

As needed

HealthPlus.org Web-based support, including access to many patient education tools, clinical guidelines and forms to promote electronic exchange of information (Provider can request mail option)

Ongoing

Physician/Provider satisfaction survey

Annually

Tobacco cessation program materials

Telephonic / Fax Referral / Website

Depression screening materials

Print Tools/Website

Weight management program

Telephonic / Fax Referral / Print Materials / Website

Web-based Krames Online patient education materials and disease specific videos

Available as needed

Journey in Caring Program for physician office staff facilitated by a CDE

Offered

Measures of Effectiveness

HealthPlus employs and tracks performance measures for each disease management program. Each measurement:

  • addresses a relevant process or outcome.
  • produces a quantitative result.
  • is population based.
  • uses data and methodology that are valid for the process or outcome measured.
  • has been analyzed in comparison to a benchmark or goal.

HEDIS® measures

Current measures include the following HEDIS® measures:

  • Hemoglobin A1c (HbA1c) testing
  • Eye exam (retinal) performed
  • LDL-C screening performed
  • LDL-C controlled (<100 mg/dL)
  • Kidney disease (nephropathy) monitored
  • BP control (<140/80 mm Hg)
  • BP control (<140/90 mm Hg)
  • HbA1c <7
  • HbA1c control (<8.0%)

Additional Measures/Outcomes

  • Member Satisfaction: HealthPlus establishes satisfaction, annually, by evaluating member survey results, complaints and inquiries.
  • Physician Satisfaction: HealthPlus establishes satisfaction, annually, by evaluating physician survey results.
  • Health care cost reduction
  • Health care utilization (in-patient, emergency department, pharmacy)
  • Annual member participation rates

For more information about the HealthPlus Disease Management Program, please contact a HealthPlus Disease Management Coordinator at (800) 345-9956, ext. 8050, or by e-mail to dismgmt@healthplus.

Additional Resources: