Up-to-date disease management news and analysis

Disease Management Update
Volume IV, No. 21
September 13, 2007

Dear Healthcare Intelligence Network Client,

In this week's Disease Management update, HIN takes a look at two new methods to combat diabetes — lowering blood pressure and treating gestational diabetes — which might reduce the risk of another all-too-common problem in the U.S. Check out HIN's blog to find out what other factor is contributing to an increase in diabetes.

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. Gestational Diabetes: Missing Link in Childhood Obesity
  2. Disease Management Q&A: Who's Footing the Bill for DM Programs?
  3. HealthSounds Podcast: Monitoring Maternity Disease Management
  4. Saving Lives in Type 2 Diabetics: As Easy as A-C-E (Inhibitors)?
  5. Curbing ED Enthusiasm

1. Gestational Diabetes: Missing Link in Childhood Obesity

A recent study by Kaiser Permanente shows a correlation between the risk of childhood obesity and a pregnant woman's blood sugar level. The study, the largest study of its kind and featured in the September issue of Diabetes Care, notes that untreated gestational diabetes nearly doubles a child's risk of becoming obese by age 5 to 7, and that treating women with gestational diabetes significantly reduces the child's risk of obesity.

For the study, researchers analyzed medical records of 9,439 mothers who gave birth between 1995 and 2000. The women were screened during pregnancy for blood sugar levels and gestational diabetes. The children were measured for weight between the ages of 5 and 7 -- a period that is a strong predictor of adult obesity. The relationship between maternal blood sugar and childhood obesity was then analyzed.

Children of mothers with high levels of blood sugar who were untreated were 89 percent more likely to be overweight and 82 percent more likely to be obese by the time they were 5 to 7 years of age, compared to children whose mothers had normal blood sugar levels during pregnancy.

"Hyperglycemia during pregnancy is clearly playing a role in America's epidemic of childhood obesity," said Teresa Hillier, MD, MS, an endocrinologist and senior investigator at CHR Northwest and Hawaii and lead author of the study. "The key finding here is that the risk of overweight and obese children rises in step with higher levels of blood sugar during pregnancy. The good news for pregnant women is that by treating gestational diabetes, your children's risk of becoming overweight or obese drops considerably."

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

2. Disease Management Q&A: Who's Footing the Bill for DM Programs?

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's experts are Dr. Eric Berman, D.O., M.S., medical director for Horizon Blue Cross Blue Shield of New Jersey, and Robin Foust, health and productivity management specialist for Zoe Consulting.

Question: Are health promotion, disease management (DM) and weight management programs covered by most healthcare organizations and HMOs or are they considered supplemental plans?

Response: (Dr. Eric Berman) Most organizations don't currently cover much in terms of obesity management, not even for providers to provide information. We are guilty of this ourselves, because of our claims engines and the codes that are used. If a mom brings her child in to talk to the pediatrician about obesity and the physician puts down obesity as the primary diagnosis, that visit doesn't get reimbursed. This is a problem we're trying to change internally.

Most health plans really don't address those issues the way that they should. And most plans, ours included, may provide for certain products three visits a year to a nutritionist. But that doesn't nearly get around to the needs of somebody who is obese or morbidly obese who wants to address their nutritional needs. We're starting to see new products that are being developed across the country by different organizations that are "value adds" for the member without additional costs for participating in the program.

Horizon no longer calls these programs "disease management." Instead, we call them health and wellness education programs. The weight management program is a pilot program with our HMO members and is a covered service. HMO members can do self-referral. They can look at a body mass index (BMI) chart or know that they're overweight and call in to be signed into the program. The return on investment (ROI) on this is great. If we have a healthier patient base, it's going to cost us less to care for these people. Hopefully in the long run, it will reduce premiums and reduce the cost of healthcare down the line.

That's really the driver for us. Take a look at pharmaceutical costs. Horizon spends over $1 billion a year covering three million members just in pharmaceutical costs alone. When you consider the statistics presented in this disease management and obesity program, you can see that simply getting people into a normal weight range reduces the amount of pharmaceutical agents and the kinds of surgeries they will require. They will be much healthier and it will cost us a lot less money to provide healthcare for them.

(Robin Foust) We're seeing more cases where obesity management is becoming part of the product portfolio through disease management organizations. There are health plans that provide disease management to their covered beneficiaries as well as self-insured employers who provide disease management. In some cases, they're adding obesity management to the mix.

There are also other wellness or health promotion programs where weight management and other behavioral change programs like smoking cessation and stress management are being covered for employees to participate through the wellness program.

To learn more about disease management and health promotion programs, please visit:

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

3. HealthSounds Podcast: Monitoring Maternity Disease Management

In this week's Disease Management podcast, Dr. Joseph Stankaitis, a chief medical officer at Monroe Plan for Medical Care, explains how incentives improved physicians' completion of his organization's prenatal registration form, and how Monroe improved coordination between its perinatal staff and behavioral health staff to address mental health or chemical dependency issues in the targeted population. Overcoming barriers to outreach is a crucial component of Health Management Corporation's telephonic Baby Benefits program, says Tom Smith, the organization's director of medical care management. And Christy L. Beaudin, PHD, LCSW, CPHQ, corporate director of quality improvement at PacifiCare Behavioral Health, describes the crucial differences between the "baby blues" and postpartum depression.

To listen to this complimentary HIN podcast, please visit:

4. Saving Lives in Type 2 Diabetics: As Easy as A-C-E (Inhibitors)?

According to a recent ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation) study presented at the European Society of Cardiology and published in The Lancet, a small reduction in blood pressure can mean a significant benefit in the treatment of patients with type 2 diabetes. For the study, 11,140 patients received either a placebo or a single pill containing a fixed combination of an ACE inhibitor (perindopril) and a thiazide-like diuretic (indapamide). According to the results, the group that received the ACE inhibitor pill experienced a 14 percent risk reduction for coronary heart disease events, 18 percent for cardiovascular deaths, 14 percent for deaths of any cause and 21 percent for developing new or worsening kidney disease.

Daniel W. Jones, M.D., president of the American Heart Association, said, “We spend both great effort and considerable financial resources in trying to treat diabetes effectively, and here is a simple and inexpensive way to save lives. Just lower the blood pressure!”

By lowering one’s blood pressure, death could be avoided among one in every 78 patients treated for five years. This translates to as many as 1.5 million preventable deaths, even if the treatment is only given to half of the world’s diabetics.

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

5. Curbing ED Enthusiasm

In an effort to curb non-emergent ED use, hospitals and health plans nationwide are developing strategies to reduce reliance on EDs for non-emergent care. HIN conducted a non-scientific online survey in July 2007 and found out how 220 organizations — including hospitals, physician organizations, health plans and more — respond to the issue of non-emergent ED use.

To download this complimentary white paper, please visit:

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