While there's no magic bullet outreach technique that motivates health plan members to be more proactive about managing diabetes, an integrated and aggressive patient education approach can achieve impressive results. Last year, when Blue Cross of California turned up the intensity of its outreach initiatives with direct mail, a telephone survey and updated educational materials, screenings among its diabetic members increased to 37% from 29% - a 30% jump.
Diabetes affects at least 70,000 members of Blue Cross' HMO and PPO plans.
The telephone survey among thousands of health plan members is what provided the most revealing snapshot of diabetics who were following appropriate health guidelines and areas where improvements were needed. The study, which was published in the February issue of Diabetes Care, found that patients who were more likely to adhere to diabetic care guidelines tended to be older, English- speaking members who:
- received diabetes nutrition counseling;
- visited a diabetes specialist physician;
- were members of a diabetes association or support group;
- used insulin; and
- complied with prescribed medication.
Outreach Improvements
Before Blue Cross overhauled its diabetes outreach initiatives, it relied primarily on an annual postcard reminder program that reminded members to get eye examinations, Hemoglobin A1C tests and foot examinations. Though the postcards are effective, they tend to reach a plateau and need to be complemented with other outreach, says Dr. Michael J. Belman, Blue Cross' medical director of medical quality management.
Although the telephone survey was an expensive endeavor it was worth the investment of tens of thousands of dollars, according to Dr. Belman. He says, "This survey helped us to recognize that any one or a combination of existing factors could preclude diabetic members from receiving recommended screening procedures."
The survey took about three months to complete and involved a team of nurses asking 3,600 health plan members at least 10 questions. The questions inquired about the type of screenings members received, their general health and whether members were satisfied with Blue Cross' quality of healthcare services and educational materials.
To reach minority members, Blue Cross conducted the survey in several different languages like Spanish, Russian, Laotian and Vietnamese.
The survey identified key barriers to patients getting recommended screenings. They included:
- confusion among members of covered diabetic services and resources;
- low access to glucose meters that are used to monitor blood sugar levels; and
- a lack of educational materials available in Spanish.
One of the most effective ways Blue Cross is addressing these barriers is to make available free glucose meters, which allow members to take better control of the disease, says Nancy Walker, who heads up Blue Cross' diabetes outreach efforts. A direct mail effort informed members about the free glucose meters and promoted a 24-hour toll-free hotline for ordering the meters. Last year, Blue Cross provided 6,000 glucose meters.
Direct mail is also being used more frequently to increase awareness about the various diabetic services Blue Cross covers and to provide members with updated educational materials. Last year, it increased its direct mail efforts to quarterly campaigns that target new diabetic members and semi-annual mailings that provide updated educational materials, which are also available in Spanish.
Targeting Physicians
Blue Cross also found that the diabetes educational materials its physicians were using were outdated. To bring physicians up to speed, Blue Cross developed a newsletter that provides updates on new HEDIS (Health Plan and Employer Data Information Set) and provider tool kits that include the latest guidelines and patient marketing materials.
This year, this information was included in a massive mailing that reached 15,000 physicians. Physicians are also sent samples of each direct mail campaign sent to health plan members.
Although Blue Cross has made significant strides in educating its diabetic members on the importance of getting screened, staying on top of its outreach needs is challenging and requires ongoing research, says Walker.
The telephone surveys have been particularly effective in keeping Blue Cross in touch with where the opportunities are for more targeted outreach among health plan members and physicians. Developing more targeted outreach initiatives will be critical for Blue Cross to achieve its HEDIS goals for next year. It wants to boost its rates from 37% to somewhere in the 40-percent-range, says Dr. Belman.
(Blue Cross of California, Dr. Michael Belman, Nancy Walker, 805/557-6790)