Health Management
Program Update

Diabetes Program
HNE wishes to extend a thank you to all the Primary Care Physicians who have participated in the Diabetes Management Program. We are pleased to share the most recent performance data from the program with you. The success of this program is due, in great part, to your participation and assistance in the process of confirmation and stratification of patients identified in your panel and the promotion of the program to your patients with diabetes.

As a refresher, the performance metrics for the Diabetes Management Program include:

1. The average number of PCP visits within a year.
2. The percent of diabetics with one or less PCP office visits within one year.
3. The average number of HgbA1c blood tests within a year.
4. The percent of diabetics receiving a retinal eye exam within a year.

Since the Diabetes Program began in July 1998, we have observed statistically significant improvements in all four of the measures. The following chart includes the baseline and two re-measurement points along with program goals for 2000.

Baseline & Measurement Chart

We are very pleased to see these results. They provide an excellent example of what is possible when network practitioners and HNE staff work closely together to improve the patients knowledge of their disease, and to improve their self- management skills.

Guideline Update
The Clinical Care Assessment Committee recently voted to adopt the Massachusetts State Diabetes Guideline with the addition of the former program guideline entitled, "Initial Assessment for Patients Newly Diagnosed with Diabetes and/or New to the Practice".

The new guidelines will be mailed out in September and can also be found at www.healthnewengland.com.

Program Additions
New to the Diabetes Program is the inclusion of the DCCT Diabetes Quality of Life questionnaire. The Clinical Care Assessment Committee reviewed a few self assessment tools and voted for the DCCT. This self assessment tool will be utilized with newly identified members with diabetes and current program participants. This questionnaire will be mailed directly to members at regular intervals (6 or 12 months) to assess the program impact on quality of life and satisfaction with the program.

If you are interested in learning more about the Diabetes Management Program or referring a patient to the program, please give the Health Education & Promotion Department a call at 787-4000, or look us up at www.healthnewengland.com, using the Health Management Program tab on the home page.

Important! Please note: The toll free diabetes information line is no longer available as a component of the program. New Diabetes Program brochures, inclusive of the program changes, are being produced and will be sent to you upon completion.

Brighter Infant Beginnings Program
OB/Pre-registration Form Reminder:
The Brighter Infant Beginnings (BIB) Program strives to be in contact with all HNE members who are pregnant. The purpose of the program is to provide a core set of educational materials to all pregnant members and to identify and manage potential high-risk pregnancies as early as possible.

Pregnant HNE members are identified through the use of the OB Pre-registration Form that you fax to HNE for each of your pregnant patients.

Once received at HNE this form enables us to:

1. Enter the authorization for payment into the claims system.
2. Mail educational materials to members.
3. Outreach to women with potential high-risk pregnancies.

In 1999 the average return rate for the OB Pre-registration Form was 85%. We want to thank you and your office staff for your efforts in making this happen.

It is important to note that when we don’t receive the form, there is an increase in the number of "missed opportunities." By "missed opportunities," we are referring to the members who actually experienced a high-risk pregnancy, but did not benefit from program services such as direct outreach/telephonic case management, coordination of care with the OB practitioner, home-based services, or receive the packet of educational materials.

Through May 31, 2000, we experienced a drop in the return rate to 81%. Please remember to fax these forms to Donna Stafilarakis, at 413-734-3356. If you are interested in obtaining a sample packet of the educational materials members receive, please call Donna at 787-4000, ext. 3391.

Asthma Program
HNE’s Asthma Management Program has included the utilizaton of a patient survey, both written and video format educational materials, and provision of peak flow meters. The targeted population has been members who are aged 18 and older meeting the following criteria: either 2 outpatient office visits with the primary diagnosis of asthma (ICD9 Code 493); one ER visit and/or one hospitalization with the primary diagnosis of asthma within a 12-month period of time.

The Health Education Staff will be expanding the Asthma Program to include: members under age 18, educational classes targeted at improving patient’s self-management skills and understanding of asthma as a disease state, and telephonic assessments.

In early June, physicians were provided with a panel report listing adult HNE members that have been identified and outreached to for participation in the asthma program. Also included with the panel reports were the asthma survey results for members that completed and returned the survey. The survey content includes self-reported information regarding a member’s knowledge about the use of a peak flow meter, proper medication usage, action plans, smoking habits and more. Now that the disease management database is nearing completion, the program staff will have the capability to generate panel reports on a quarterly basis. The panel reports will be forwarded to you, with completed surveys from your patients, in a more timely manner. As the program matures, we will produce more sophisticated reports to share with you.

Following the last edition of HealthScript, we received a number of calls from providers who were interested in receiving a sample packet of the educational materials that we use in the Asthma Program. If you would like a sample packet of educational materials or if you have any questions, please contact Krista O’Shea, at 413-787-4000, ext. 3327.

"Caterpillar to Butterfly Campaign"- A Great Success
The "Caterpillar to Butterfly" campaign is one of the ways HNE promotes timely immunizations and well child visits. It includes posters and postcards for use in pediatrician and family practice offices. The posters can be displayed in waiting/ exam rooms, and the postcards may be used as either take-home reminders for parents or mailed out as a reminder of a scheduled appointment. The postcards are not specific to HNE members and can be used for all patients. All network pediatricians and family practitioners received these materials, and the response has been very positive with a number of practices requesting additional posters and postcards. If you would like to obtain more materials for your office please contact
Lynn Ostrowski at 413-787-4000, ext. 3383.

Routine Preventive Care Recommendations
The Clinical Care Assessment Committee made a change to the 2000 Adult Preventive Health Recommendations. This change is specific to the colorectal/polyp and cancer screening recommendation. The update is as follows (see chart):

	19-29 yrs.	30-39 yrs.	40-49 yrs.	50-64 yrs.	65+ yrs
Colorectol Polyp & Cancer Screening	Average & moderate risk - not routine High risk - options every 2 yrs. include endoscopy, counseling to consider genetic testing, referral for specialty care & colono-scopy with or without biopsies.	Average risk - not routine Moderate risk - not routine unless youngest case in the family within this age range. High risk - every 2 yrs. as per previous statement (19-29 yrs. section)	Average risk - not routine Moderate risk - by 40 or 10 yrs. before the youngest case in the family. High risk - every 5 yrs. as per previous statement (19-29 yrs. section)	Average risk - annual fecal occult blood testing (FOBT), flexible sigmoidoscopy, FOBT & flexible sigmoidoscopy every 5 yrs; double ontrast barium enema (DCBE) every 5-10 yrs; or colonoscopy every 10 yrs. Moderate risk - colonoscopy or DCBE High risk - all options previously referenced

These are minimum recommendations applicable to both females and males (unless otherwise stated). The interventions listed are not exhausted and variations may be appropriate.

Each year all members receive the Preventive Health Recommendations. The goal is to raise their awareness and encourage them to make appointments for the appropriate screenings. These postcards were mailed to members as part of the most recent Member Matters newsletter.

The Routine Preventive Care Recommendations can be found on our Web site at www.healthnewengland.com. Click on the Health Management Program button.