Diabetes Care Best Practices Compendium
Diabetes Care Best Practices Compendium
Medicaid Health Plans of America Center for Best Practices DIABETES CONTROL Diabetes Care Best Practices Compendium
table of contents | 3 Table of Contents Welcome About the MHPA Center for Best Practices . 5 Welcome Letter: A Message from Michelle Martin . 7 Chapter 1: About Diabetes . 8 Chapter 2: Diabetes Prevention . 12 Chapter 3: Reducing Diabetes Racial and Ethnic Disparities . 13 Chapter 4: Medicaid Health Plans – Innovations in Improving Diabetes Care . 16 Chapter 5: Health Plan Best Practices . 21 Buckeye Community Health Plan and AT&T mHealth Solutions Presents DiabetesManager® [Buckeye Community Health Plan (Centene® Corporation) and AT&T/WellDoc .
21 Community Health Worker Program (UPMC for You . 24 Diabetes Control Network (Midwest Health Plan . 25 Diabetes Education for SMI [Nurse Wise/Nurse Response (Centene . 28 Diabetes Total Wellness Initiative: Learning to Live and Thrive with Diabetes (Amerigroup Maryland . 29 Drug Therapy Management (DTM) Program for Diabetics (PerformRx, AmeriHealth Mercy Health Plan and Keystone Mercy Health Plan . 31 Get Control It Matters (Delaware Physicians Care, An Aetna Health Plan . 34 HealthConnections: Community-Based Disease Management Pilot - Diabetes (WellCare Health Plans, Inc . 37 Healthy Families Program (Amerigroup Corporation .
38 In Control Diabetes Care Management (Select Health of South Carolina . 40 MDwise Rewards Program (MDwise, Inc . 41 The mHealth Program (DC Chartered Health Plan, Inc . 43 Monitoring for Risk of Metabolic Syndrome (Value Behavioral Health of Pennsylvania . 45 Nurtur’s Diabetes Program (Centene® Corporation . 48 VSHP Diabetes Gaps-In-Care (Volunteer State Health Plan and BlueCross BlueShield of Tennessee . 49 YOU Count (Health Partners of Philadelphia, Inc . 51 Chapter 6: Diabetes Resources . 52
4 | Diabetes Care Best Practices Compendium About MHPA Center for Best Practices The Medicaid Health Plans of America (MHPA) Center for Best Practices (CBP) is a 501(c)(3) affiliate organization created to support MHPA’s mission: to provide efficient health care services and improve quality and access to care for Medicaid beneficiaries. The CBP serves as a convener of Medicaid health plans on research, quality improvement and dissemination of health plan best practices in both clinical and operational domains. With guidance from the leadership of premier health plans serving Medicaid populations and expert stakeholders, the CBP uses data, information and knowledge transfer to disseminate innovative solutions to caring for underserved populations.
Welcome | 5 MHPA Center for Best Practices Best Practices Compendium on Diabetes Care By Liza Greenberg, RN, MPH, MHPA Senior Consultant, Clinical Initiatives Layout and design by Karen Seidman, Seidman Says Communications ~~~ The MHPA Center for Best Practices thanks the member plans that submitted best practices for this publication. We are also grateful to the other MHPA members who offered guidance, insights and comments on drafts of this document. Any errors in this compendium are the responsibility of the author. ~~~ Supported by an educational grant from Roche Diagnostics ~~~ Copyright © 2013 Medicaid Health Plans of America Center for Best Practices ~~~ MHPA Center for Best Practices 1150 18th Street, NW Suite 1010 Washington, DC 20036 Tel: (202) 857-5720 | Fax: (202) 857-5731 email@example.com | www.centerforbestpractices.org
6 | Diabetes Care Best Practices Compendium Welcome Letter A Message from the MHPA Center for Best Practices Director Michelle M. Martin Dear Colleagues: On behalf of the MHPA Center for Best Practices, I am pleased to bring you this Diabetes Care Best Practices Compendium. Diabetes is one of the most common chronic diseases affecting members of Medicaid plans. More than 8% of the U.S. population has diabetes and the risk of diabetes is higher in low income and some minority groups — precisely the populations served by Medicaid health plans. One of the key objectives of Medicaid health plans is to close these health care quality gaps and reduce disparities.
This publication provides information on best practices in diabetes care and highlights programs from MHPA health plans and partner organizations. These descriptions illustrate efforts to educate, engage, and ensure high-quality treatment for Medicaid enrollees with diabetes. Plans are offering specialized programs to identify members with diabetes, link them with care managers and health care services, and measure changes in delivery of essential diabetes treatments. Health plans are also taking a leadership role in working with communities to improve health and prevent diabetes. Plans also educate physicians and other health care providers, and often use health plan data to show providers where members are lacking in diabetes care.
These patient- and provider-directed efforts help to narrow the gaps in diabetes care quality. Prevention of diabetes is a key area of emphasis for health plans. Medicaid health plans have a variety of diabetes prevention programs and collaborations to promote physical activity, encourage healthy eating, and help people maintain a healthy weight. Health plan prevention approaches are multi-faceted and include community- based strategies, programs to support clinicians in improving care, and programs to educate patients. These interventions are critical to stem the rising tide of diabetes.
This publication offers information for Medicaid health plans, state leaders, and other policymakers. It also lists resources with website links that can help readers find information about preventing and managing diabetes. We commend the health plans featured in this publication and encourage all stakeholders to work together in the fight against diabetes. Sincerely, Michelle M. Martin Director, MHPA Center for Best Practices welcome | 7
8 | Diabetes Care Best Practices Compendium Chapter 1: About Diabetes Diabetes is a critical health issue for the United States and for Medicaid health plans.
An estimated 26 million, or approximately 8% of U.S. residents have diabetes. That number is higher among racial and ethnic minority populations; almost 13% of adult African-Americans and 12% of Hispanic populations have been diagnosed with diabetes. Diabetes is also more prevalent in the elderly and low income populations — meaning that it is an important issue for health plans serving these Medicaid beneficiaries.
Also of great concern is the potential for future cases of type 2 diabetes: 35% of adults over 20 have signs and symptoms of prediabetes. Prediabetes may progress to type 2 diabetes unless people adopt healthy behaviors. It is often reversible through changes in diet and exercise resulting in weight loss. Obesity is a key driver of diabetes. With a third of the population now clinically obese, the toll of diabetes may continue to rise. Some racial or ethnic minority groups are at particularly high risk for the development of diabetes related to obesity. Preventing obesity as a nation, and treating weight problems for individuals with diabetes and prediabetes is an essential strategy.
It is a national priority to improve nutrition and lifestyle — starting in childhood — to prevent obesity. National efforts to prevent diabetes often focus on developing programs and policies that will create a healthy environment that prevents obesity.
What is Diabetes? Type 1 diabetes stems from the body’s inability to make insulin which helps process glucose (sugar) for energy. Type 1 represents a small percentage (5-10%) of all persons with diabetes. Type 2 diabetes is the most common form of diabetes. Type 2 diabetes is the result of both reduced insulin secretion and reduced insulin effectiveness, conditions known as insulin resistance. Because insulin is necessary to metabolize glucose in the body, absent or insufficient insulin results in high blood sugar (hyperglycemia).
Type 2 diabetes can sometimes be controlled with diet and exercise, but medications are often required.
Type 1 must be treated with insulin. Controlling diabetes will prevent damage to other body systems, including end stage kidney disease and blindness. Diabetes treatment also focuses on controlling hypertension and elevated cholesterol, which lowers the patient’s risk for cardiovascular disease linked to diabetes. Why So Much Emphasis on Diabetes Care? Diabetes affects the health and productivity of the patients and families who live with it. For most people, type 2 diabetes is a progressive disease that triggers a cascade of “co-morbidities” or other health problems. Despite knowledge of effective strategies to manage diabetes, treatment adherence Narrative | 9 to both lifestyle and medication recommendations remains low.
The statistics outlined below demonstrate how diabetes contribute to poor health outcomes. For example, according to the National Institutes of Health: Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes.
The risk for stroke is two to four times higher among people with diabetes. Up to 67% of diabetics have blood pressure greater than or equal to 140/90 mmHg or use prescription medications for hypertension. Diabetes is the leading cause of new cases of blindness among adults ages 20–74 years. Diabetes is the leading cause of kidney failure, with almost 50,000 new cases each year. 60-70% of people with diabetes have mild to severe neuropathy (nerve damage), and 60% of non- traumatic amputations are in people with diabetes. 1 How Can Diabetes be Treated More Effectively?
The goal of treatment for type 2 diabetes is maintaining near normal or target range blood sugar levels and preventing complications.
Successful management includes both medical interventions and patient adoption of a healthy lifestyle with nutritious eating and regular exercise. High quality diabetes care is often called “evidence-based care” because it is consistent with treatment that research evidence shows will produce the best health outcomes. Treatment goals for type 2 diabetes include: Hemoglobin A1c (HbA1c) control, with checks every three to six months Blood pressure control at 130/80 mm/Hg or lower Cholesterol and triglyceride levels management with annual checks (LDL cholesterol levels below 70-100 mg/dL) Annual kidney function tests (microalbuminuria and serum creatinine) Annual eye exams to check for diabetic eye disease, or more frequently as needed Regular dental cleanings and exams Smoking cessation treatment, if needed Adoption of regular exercise program Diabetes self-management education Standards of Care for Diabetes Type 2 diabetes is a complex and progressive condition.
Treatment requires control of the diabetes-specific symptoms – high or low blood sugar – and also careful attention to preventing and treating complications.
Each year additional research results in new recommendations for diabetes treatment. The American Diabetes Association has taken the lead in convening physicians and other diabetes experts to establish standards of care for diabetes. In 2012 the American Diabetes Association partnered with the European Association for the Study of Diabetes and issued new recommendations on delivering treatments that meet the needs of specific types of patients such as the elderly, chronically ill, and newly diagnosed. This is a change from prior treatment guidelines that had a uniform HbA1c management goal for all patients.
Links to the 2012 standards, along with a summary of changes and tools to help physicians quickly identify care management goals, are identified in the Resources section of this Compendium. _ _ 1 http://diabetes.niddk.nih.gov/dm/pubs/statistics/#pdc