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Talking with Payers, Providers and Patients About Diabetes:
An AAPPO Toolkit for PPOs
Tab 5: What Can Payers Do: Screening Programs
Diabetes can be delayed or prevented with successful identification and behavior change in people at risk. Fifty-four million people have pre-diabetes, a condition in which blood glucose levels are higher than normal, and millions more are overweight or inactive – conditions that increase risk of disease. In addition, those who already have diabetes are at significantly greater risk for developing co-morbidities. Screening programs are a way to identify risk for diabetes (or other chronic diseases) or identify early disease.
There are two types of screening: 1) clinical– checking blood sugar – and 2) risk factor screening. Clinical screening is usually a covered service delivered by the patients’ health care providers. Health risk assessments (HRAs) are written risk factor screening tools. They can be offered by employers or health plans to help patients understand their risk of disease or complications. There are diabetes-specific HRAs, or general HRAs. HRAs are also available for free on the internet from sources such as the American Diabetes Association. PPOs can work with payers to offer a health risk assessment tool and develop systems for appropriate follow up.
Resources for payers: (also see Tab 11)
University of Michigan Health Management Research Center
http://www.hmrc.umich.edu/services/hra.html
Points to Make with Payers (Employers, Insurers, Plans):
Diabetes can be delayed or prevented with successful identification and behavior change in people at risk. Fifty-four million people have pre-diabetes, a condition in which blood glucose levels are higher than normal, and millions more are overweight or inactive – conditions that increase risk of disease. In addition, those who already have diabetes are at significantly greater risk for developing co-morbidities. Screening programs are a way to identify risk for diabetes (or other chronic diseases) or identify early disease. There are two types of screening: 1) clinical– checking blood sugar – and 2) risk factor screening. Clinical screening is usually a covered service delivered by the patients’ health care providers. Health risk assessments (HRAs) are written risk factor screening tools. They can be offered by employers or health plans to help patients understand their risk of disease or complications. There are diabetes-specific HRAs, or general HRAs. HRAs are also available for free on the internet from sources such as the American Diabetes Association. PPOs can work with payers to offer a health risk assessment tool and develop systems for appropriate follow up. (also see )
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HRAs are designed to identify modifiable risk factors including smoking, alcohol use, and inactivity that impact many chronic diseases, including diabetes. They can also identify groups of people with overall higher risk, who may benefit from early diabetes clinical screening and regular checks for cardiovascular disease.
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Where resources are limited, it may be most effective to focus screening programs on people with known risk factors such as high blood pressure. HRAs have the most impact when they are coupled with health information and referrals for interventions such as treatment, counseling or other therapy.
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Payers can offer a health risk assessment a health benefit and use the data to trigger health management interventions. HRAs can be designed to report a risk “score” to patients, and may also report summary data to the sponsor. Aggregate information from HRAs helps the payer to understand common risk factors and health conditions in the covered population. Many payers offers incentives for patients to complete a health risk assessment. Protection of patient / employee privacy is a key consideration in HRA programs.
The National Business Group on Health collaborated with CDC to produce A Purchasers Guide to Clinical Preventive Services: Moving Science into Coverage. NBGH recommends screening high risk individuals for diabetes and establishes the economic benefits of preventive intervention. NBGH also recommends identification of risk factors (such as through an HRA), as a precursor to effective diabetes prevention and management. www.businessgrouphealth.org/benefitstopics/topics/purchasers/
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Copyright AAPPO April, 2008
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