Health plan, community team up for DM

Health plan, community team up for DM

Patients receive education in a familiar setting

In addition to developing its own disease management programs, WellCare Health Plans is partnering with organizations that provide social safety net services to implement the programs for their members with diabetes.

The arrangement is a win-win situation for all the parties, says Pamme Taylor, vice president for advocacy and community-based programs for WellCare Health Plans, headquartered in Tampa, FL. "Our members receive education on managing their conditions from an organization they trust, the organizations receive funds they need to stay afloat, and we have an effective disease management program," Taylor adds.

The program began as a unique private/public/academic venture. WellCare worked with Texas A&M Health Science Center to establish a partnership with community organizations to train individuals to implement the Stanford Chronic Disease/Diabetes Self-Management programs.

"When we started the initiative, we looked for partners that provide essential services in the community and identified programs that used evidence-based protocols. We chose to use a network of organizations with public assistance programs," Taylor says.

After the successful pilot with Texas A&M, WellCare began contracting directly with the agencies to provide the program using the Stanford Diabetes Self-Management curriculum.

The staff at the social safety net organizations undergo extensive training on how to administer the program.

The economic downturn in recent years has resulted in spending cuts for social safety net organizations at the same time that more people are seeking assistance, Taylor points out.

"Funding cuts make it harder for people in great need to access social services, which ultimately has an impact on health conditions. We need those organizations to serve our patients and help them access the social assistance they need so they can concentrate on their health," she says.

An added benefit of partnering with local social safety net organizations is that many people that WellCare serves are already receiving services from those organizations in their community, Taylor says. They are familiar with the organizations, trust them, and know where they are located. "People are more likely to follow advice if they receive disease management education from organizations where they already receive services," she says.

The Diabetes Self-Management Program is a series of classes that aim to help members take control of their health and achieve a better quality of life, Taylor says. The classes involve more than just lectures. Participants learn how to apply the lessons they learn. For instance, a dietician teaches how to make healthy food choices on a budget, and a professional chef comes in to teach healthy cooking techniques.

"The program is designed to give people with diabetes the knowledge and skills needed to modify their behavior and successfully self-manage the disease and its related conditions," Taylor says.

WellCare identifies members eligible for the program through claims data and referrals from case managers and disease managers at the company. Each member completes a health risk assessment that guides the level of the interventions, she says. In addition, WellCare has informed providers in the community about the program and encourages them to refer eligible members.

The interdisciplinary case management team at WellCare stratifies members with chronic diseases to determine their need for interventions and develops an individual plan for those who are at risk. "Members with chronic illnesses have very different needs. The plan depends on their conditions, their overall health, and caregiver support, and may or may not include the community-based classes," Taylor says.

When members are identified as eligible for the program, a WellCare case manager contacts them and explains how the program works.

Whenever possible, the health plan refers members to an organization in their community for the diabetes disease management classes. If there isn't a program available in their community, the members are referred to WellCare's own disease management program.

"Whenever possible, we try to use what exists in the community. Members are familiar with the community organization and it's more effective for them to receive education from an organization in their local area," she says.

WellCare tracks the number of members referred to the program, the number of members who enroll, and how many completed the program in the pilot phase. It's too soon for statistical outcomes, Taylor says, but anecdotally, the program has been a success.

"Through our partnership with Texas A&M Health Science Center, we originally planned to implement the program in 20 sites. We now are up to 84 and we are expanding the program to all markets, not just members receiving Medicaid benefits. Our goal is to quantify the impact of the social safety net on health outcomes, while we help our members live happier, healthier lives," she says. n