diabetes-related hospital inpatient stay or emergency potential diabetics through a diabetes fax-back form. UniCare Diabetes Management Program staff provide …
WEST VIRGINIA
DIABETES MANAGEMENT PROGRAM DESCRIPTION
State Sponsored Business
UniCare Health Plan of West Virginia, Inc UniCare is committed to collaborating with physicians to help find ways to improve the health of its members with chronic conditions The Diabetes Management Program is designed to help improve health care outcomes and increase member and provider satisfaction A population-based health model is used in the form of interventions that rely on clinical support tools and member education Interventions focus on: Information about acute, long-term, home- and community-based care Behavior modification Member and provider education
UniCare is a WellPoint Company
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Patient Interventions
Identification of Participants
The following criteria are used to identify members for the program: Members with two face-to-face encounters on different dates of service in an ambulatory setting or a nonacute inpatient setting with a diagnosis of diabetes, or Members with one face-to-face encounter in an acute inpatient or emergency room setting with a diagnosis of diabetes
Interventions
Members are contacted by mail to enroll in the program Interventions include:
Registry All Levels Members are added to the registry database to monitor potential stratification level changes and adjust interventions accordingly Communication with primary care providers PCPs helps ensure registry accuracy Diabetic Retinal Eye Exam Reminder Card All Levels Members who have not had a diabetic retinal eye exam within the last year under the plans benefits and meet the HEDIS criteria for a diabetic diagnosis are sent a UniCare Diabetic Retinal Eye Exam Reminder Card Member Education Packet Levels 2 and 3 Members receive a diabetes eduction packet that includes: Welcome letter with a choice to opt out of the Diabetes Management Program Important UniCare phone numbers resource reference list Diabetes Health Record Card Living Your Life with Diabetes booklet addresses lifestyle issues Control Your Diabetes For Life and Know Your Blood Sugar Numbers brochures Case Management Referral for High-Risk Diabetics Level 3 In some cases, patients require intensive monitoring and instruction These patients will be case-managed by registered nurses trained in diabetes management
Stratification
A members stratification allows UniCare to determine the frequency and
intensity of interventions the member may receive as part of the disease management program, based on UniCare claims and pharmacy data Members are stratified based on three levels: Level 1 low-risk represents diabetic members who, based on claims, have a diagnosis of diabetes and have no existing comorbid conditions Level 2 moderate-risk represents diabetic members who have a diagnosis of diabetes and have a comorbid condition Level 3 high-risk represents members who have a diabetes-related hospital inpatient stay or emergency room visits, and have an existing comorbidity Evidence 
of disease management through claims data and primary care provider feedback is also considered and documented in the diabetes database for all stratification levels
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Provider Components
Primary Care Provider PCP Involvement
Diabetes provider materials are available on the UniCare provider website UniCare diabetes provider materials include: Welcome letter introducing the program and how it assists members Program item checklist Introduction flyer listing member services and other important phone numbers Preferred practice guidelines for diabetes care includes a website reference for
updates Member educational materials Screening algorithms Flow sheet Diabetes Health Record Card Reorder form UniCare notifies providers of patients identified as potential diabetics through a diabetes fax-back form Providers are asked to respond if the patients listed in the fax are not diabetic or have not been seen by them This promotes communication between UniCare and the PCPs and helps identify at-risk patients
The Diabetes Management Program is designed to achieve these goals:
Educate members and providers about diabetes management Increase adherence to clinical support tools and to the American Diabetes Associations clinical practice recommendations Reduce variations in practice patterns for diabetes treatment Promote an interactive approach to diabetes care by using action/goal plans and behavior modification techniques, facilitating patient and providers communication, and encouraging members to take a more active role in managing their disease Improve members self-management skills for diabetes through education
Summary
The Diabetes Management Program helps diabetic members understand and manage their disease for a better quality of life The program was
developed specifically for UniCare members and focuses on their need for additional follow-up, support, and better health plan services The diabetic member, primary care provider, home health agency, and UniCare work together to meet program goals Please encourage your patients to participate in the program Call us with questions and concerns at:
Follow-up and Support
UniCare Diabetes Management Program staff provide monitoring and follow-up with diabetic members as they progress through the program Referrals to community programs, such as support groups and health education programs, are provided Interpreter services and transportation are arranged when needed
1-866-513-8352
Outcome Measures
The following outcome measures are used for the Diabetes Management Program: Number of patients with diabetes receiving annually: At least one A1c test At least one dilated retinal eye exam At least one serum lipid test A urinary microalbumin test Inpatient hospitalization and outpatient emergency room usage
Registered mark and SM service mark of WellPoint, Inc WV0010800 10/04
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Source:dmv.ca.gov
