Developing strategic disease management programs is essential to strengthening managed care relationships. Effective and timely interventions with a chronic disease population, like sufferers of diabetes, cancer and cardiac disease, can improve the health of high-risk patient groups and bolster your organization's cost-savings initiatives - key considerations for health plans.
These efforts require consistent messaging to physicians and other healthcare providers and consistent communications with patients, according to American Healthcorp, a company that has built a reputation for aggressive diabetes control programs and is now expanding into cardiac care. American Healthcorp's wholly-owned subsidiary, Diabetes Treatment Centers of America (DTCA), works with seven large HMOs and approximately 107,000 people with diabetes in 30 markets. Its diabetes model promises to deliver in the first year savings that exceed the program's cost.
For instance, the program saves HMOs an average of $50 per member, per month for annual savings of $600. In addition, diabetic hospital admissions can be expected to decrease by 18 percent and bed days by 21 percent, says Robert Stone, American Healthcorp's SVP.
Physician Communications
Physician buy-in is key to the success of disease management programs. "Effective healthcare delivery comes down to the doctor-patient relationship," says Stone. To this end, DTCA communicates with physicians using a variety of tools, including:
- Profiles of individual physicians, evaluating where they are in achieving diabetes care management goals based on guidelines by the American Diabetes Association;
- Medical education seminars on cutting edge diabetes treatments and services;
- Updates on where improvements in diabetes management are needed.
- Updates on DTCA's communications to patients.
This diabetes model is delivering encouraging preliminary results for Cigna, especially in the key preventive areas of reduced hospital days, increased blood testing and eye exams. Cigna started working with DTCA about a year-and-a-half ago to improve outcomes in 11 standards of care developed by the ADA, including foot exams, blood pressure tests and encouraging healthy lifestyle habits. Although Cigna is in the process of auditing the program, VP of quality and strategic medical affairs Dr. Victor Villagra says the model helps the health plan focus more on best practices rather than customary practices with an emphasis on helping physicians accomplish treatment goals.
On the Cancer Front
If you're looking to develop custom outreach initiatives for cancer patients, the National Cancer Institute (NCI) partners with organizations on a regional basis to provide communication strategies for underserved populations. Using a "cluster" approach to targeting key audiences, NCI provides outreach strategies based on a patient's social rank, mobility, ethnicity, family life cycle and housing style, says Anne Lubenow, program specialist at NCI's office of cancer communications.
And Vida Healthcare, a cancer disease management and information services company in Minneapolis, works with managed care organizations to develop evidence-based, consensus-driven clinical practice guidelines for various types of cancer.
Last month, United Healthcare of New England began implementing Vida Healthcare's WayPoint Clinical Practice Guidelines for treating breast, lung colorectal, ovarian and prostate malignancies. United Healthcare has 210,000 members, including 30,000 Medicare recipients.
To earn clinical credibility, Vida formed a New England Medical Advisory Board to develop the WayPoint guidelines, which reflect regional academic philosophies and community-based practice styles. The medical board is comprised of at least eight physicians from area academic hospitals, community hospitals and group practices who have specialization in oncology, radiology and surgery.
(American HealthCorp, Robert Stone, 615/665-7760, Cigna, Dr. Victor Villagra, 860/726-3016; NCI, Ann 301/496-4000; Vida Healthcare, http://www.vidahealth.com)
Fast Facts About Diabetes
- In the U.S., diabetes care commands $1 of every $7 spent on healthcare.
- Because of chronic complications, medical expenditures for people with diabetes are almost four times as high as people without diabetes.
- In 1992, medical expenses for diabetics were estimated to be $105 billion, however, only 16% are directly attributable to diabetes care. The remainder went to routine medical care, chronic complications and other medical conditions like liver disease and gastritis.
- Source: The Endocrine Society/DTCA