Disease Management Update
Volume IV, No. 18
August 23, 2007

Dear Healthcare Intelligence Network Client,

This week's Disease Management update looks at the dangers associated with diabetes as well as steps and strategies patients can take to change their unhealthy lifestyle habits. A recent study links diabetes to adverse housing conditions, suggesting that our environments play bigger roles in our health than we may think. Check out this week's blog entry for a response to this study.

Your colleague in the business of healthcare,
Laura M. Greene
Editor, Disease Management Update

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at: http://www.hin.com/dmdesktop/diseasemanagement.html

Table of Contents

  1. No Place Like Home to Contribute to Diabetes Risk
  2. Disease Management Q&A: The PCP's Role in Weight Management
  3. HealthSounds Podcast: Identifying Potential Members for Diabetes Disease Management and Avoiding Complications
  4. Diabetes Significantly Increases the Risk of Death in Heart Patients
  5. Changing Lives with Lifestyle Management

1. No Place Like Home to Contribute to Diabetes Risk

Fair or poor housing conditions are associated with the risk of developing diabetes in urban, middle-aged African-Americans according to researchers from the Indiana University (IU) School of Medicine, the Regenstrief Institute, Washington University in St. Louis and other institutions.

The study observed men and women in their homes and environments in a poor, inner city St. Louis area and a less impoverished, suburban area that included several pockets of residents from a variety of socioeconomic backgrounds. Researchers found that housing conditions influenced the risk of developing diabetes.

"We found a strong link between housing and diabetes risk but it's not clear exactly how housing conditions are exerting this influence," says study senior author Douglas K. Miller, M.D., Richard M. Fairbanks Professor in Aging Research at IU School of Medicine and a Regenstrief Institute research scientist. "However, it is clear that it won't be possible to reduce disparities in health status among subgroups in the population and thus improve health without understanding how a person's environment can affect that person's health."

The researchers say that additional studies are needed to determine what specifically increased the risk of diabetes as a result of poor housing conditions, but many factors have already been ruled out.

To learn more about the findings of this study, please visit:

2. Disease Management Q&A: The PCP's Role in Weight Management

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's experts are Robin Foust, population/individual health and productivity management specialist for Zoe Consulting, and Dr. Eric Berman, medical director and chairman of health policy, Horizon BCBS of NJ.

Question: Are you involving the participants' primary care physicians (PCPs) with weight management?

Response: Response: (Robin Foust) In the MediCorp program, the PCP is pulled into some of the initial testing that has to be done. Through the Associate Wellness Program, the health coach gives a patient a form their physician must complete. The patient must have a medical exam and the physician must approve entry into the weight management program. There is communication with that patient's physician to support the change process and what's going on with this patient both clinically and behaviorally.

(Dr. Eric Berman) Horizon has not incorporated the PCP, because it's difficult. It depends on what kind of HMO model you're using. If you have a physician gatekeeper model, then it's difficult because most PCPs would do nothing more than just say whether the patient has an abnormal body mass index (BMI) and refer them to a weight management program. It's very time-consuming for PCPs to work with a patient on an individual basis.

You probably could get more bang for the buck if the HMO developed a program that your members could access, or if you approved other programs like Weight Watchers or offered other incentives. There was a program in California where participants were paid $1,000 if they reduced their weight and got into the normal BMI classification. Participants were paid half of the money up front for getting into a normal range and then the other half of the money six months later if they maintained that weight. Health plans are starting to look at a lot of incentives.

It might be good to develop a program where the PCP can focus on group projects where they would invite 20 to 50 people who are interested in this and then give a seminar and try to get them enrolled in a program that is effective.

It is difficult to change personal behavior. At Horizon we try to allow the members to find a method they feel comfortable with. Some people may like Weight Watchers, and some people may not. Other people may like going to a health club, other people would just like to start walking. And I think you have to individualize it because everybody is different and you have to allow for variety, because the same thing is not going to work for each person. Again, putting forth a very simple message of reducing portion size, eating the right kind of foods and starting to walk would be a good way to start the program.

To learn more about disease management strategies focused on obesity, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

3. HealthSounds Podcast: Identifying Potential Members for Diabetes Disease Management and Avoiding Complications

In this week's Disease Management podcast, David Larsen, director of quality improvement at SelectHealth, provides a brief overview on how technology is having a big impact on performance improvement and Healthcare Effectiveness Data and Information Set (HEDIS) results at SelectHealth.

Larsen, along with Dr. Jaan Sidorov, medical director, of Geisinger Health Plan, described how their programs identify potential members for diabetes disease management programs, the interventions given and the impact these programs are having on patient outcomes and the bottom line during an audio conference, Diabetes Disease Management: Practical Strategies for Identifying At-Risk Populations and Avoiding Complications.

To listen to this complimentary HIN podcast, please visit:

4. Diabetes Significantly Increases the Risk of Death in Heart Patients

Researchers from the Thrombolysis in Myocardial Infarction (TIMI) Study Group in Brigham and Women's Hospital's (BWH) cardiovascular division found that after 30 days, the risk of death for diabetics experiencing acute coronary syndromes (ACS) was two times greater compared to non-diabetic individuals experiencing the same type of coronary event. The analysis group was comprised of more than 62,000 individuals -- more than 10,000 of whom were diabetic -- from 55 countries and more than 900 clinical sites.

Those in the study with diabetes who experienced ACS were older, more often women, had higher BMI and were more likely to have a history of high blood pressure, high cholesterol levels, past heart attack, coronary bypass surgery and heart failure compared with the non-diabetics in the study. Additionally, of the 55 countries and 900 clinical sites pooled for this study, there was a higher prevalence of diabetes in the North American sites compared with the other regions around the world.

To see more of this survey's results, please visit:

5. Changing Lives with Lifestyle Management

Abandoning long-standing behaviors that are detrimental to one’s health is no simple feat, but it is necessary for an increasing number of people with life-threatening conditions such as diabetes, heart disease and obesity. This is why healthcare organizations are aiding such undertakings with lifestyle management (LM) programs. This executive summary provides the general character of more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.

To download this complimentary white paper, please visit:

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