by Ami Cole, Plan President at Molina Healthcare of Ohio, Inc. | Ohio Association of Health Plans
Ohio’s Medicaid Managed Care plans work collaboratively every day to help support the over 3 million Medicaid recipients we are privileged to serve. In this effort, we have learned about the many challenges members face in accessing care and staying healthy. Some of the most difficult struggles involve chronic conditions such as asthma, diabetes, hypertension and high cholesterol. What we’ve learned, above all, is when it comes to making a difference on these persistent problems, we can be more effective by working together.
That’s why Aetna, Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage and UnitedHealthcare are working together on a plan to target one of our most destructive adversaries: uncontrolled diabetes.
Knowing that members who don’t get their diabetes under control face heightened risks of heart attack, stroke, blindness and kidney problems, we’ve established two clear goals. First, to increase the number of members with diabetes who get their A1C tests, understand their numbers and take appropriate steps to control their diabetes. Second, to help more members with diabetes control it by achieving A1C values below 9%.
To achieve these goals, the Medicaid plans have worked on several initiatives this year to make it easier for providers to treat their patients with diabetes, and for members to get access to needed supplies and additional services and supports that will help them better manage their chronic condition. This work started with plans aligning processes for diabetic supplies. We standardized quantity limits to simplify how members get their diabetic supplies so they can check their blood sugar levels as frequently as required.
Additionally, plans partnered with vendors and pharmacists to make those supplies available at the corner drugstore. Plans are now testing expanded access to continuous glucose monitors to allow individuals to remotely report their blood sugar levels to their primary care provider on a daily basis for real-time medication adjustments and counseling, as needed.
We also identified an opportunity to further promote the use of Diabetes Self-Management Education (DSME) training to help members learn more about tools and resources to control their disease. DSME can help members learn skills to manage diabetes more effectively by checking blood sugar regularly, eating healthy food, being active, taking medicines as prescribed and handling stress.
This program is led by diabetes educators such as registered nurses, registered dietitians or pharmacists. The program can be taught in group or individual settings and can be offered in person, online or by phone. DSME has been shown to lower A1C levels, prevent or reduce diabetes complications, improve quality of life and lower medical expenses.
DSME will become a covered benefit in 2021 but in the interim, the Medicaid plans elected to cover this as a value-added service and are working to get the word out. We want providers to know they can now refer their Medicaid patients to DSME programs to help patients get additional services to enhance their diabetic care.
As always, plan care coordinators, who are licensed clinicians such as nurses and social workers, continue to provide added support through ongoing outreach to members with diabetes to remind them when it’s time to visit their primary care provider and arrange transportation, if needed. They also provide added supports to physicians by helping members get connected to services, such as DSME, and connecting them with other social service supports to address social determinants of health including food insecurity and housing needs.
Plans are mailing A1C test kits, along with instructions for completing the test in their homes, to members who have not had a recent A1C test. We ask that the member return the completed tests so we may share them with their primary care provider. The plans are calling members to ensure they receive the test kit and to offer any assistance with questions they may have.
Each plan is committed to continuing to explore and evaluate ways to best help our members living with diabetes. We’re excited about the difference this initiative could make for our members and health care partners, and we’re proud of the cooperative effort that makes it possible.
It’s just one of many ways Ohio’s health plans are partnering with providers, regulators and members to do better for the people we serve by building a healthier Ohio together.
Learn more in Shield HealthCare’s Diabetes Community.
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