Disease Management Update
Volume IV, No. 23
September 27, 2007

Dear Healthcare Intelligence Network Client,

This week's Disease Management Update looks at Alzheimer's disease and Parkinson's disease and certain factors that can trigger or suppress these illnesses. Don't forget to visit HIN's blog to read about the Medicare Advantage Special Needs Plan for Alzheimerís disease and chronic dementia patients as well as some stats from the National Institute of Mental Health.

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. A Mediterranean Meal a Day Keeps the Alzheimer's at Bay
  2. Disease Management Q&A: Integrating Utilization and Mental Health Responsibilities
  3. HealthSounds Podcast: Managing Transitions to Care for the Frail Elderly
  4. Gene Abnormality Related to Early Onset of Parkinsonís Disease
  5. Disease Management: Definition, Benchmarks, Metrics

1. A Mediterranean Meal a Day Keeps the Alzheimer's at Bay

A Mediterranean diet may help people with Alzheimerís disease live longer than patients who eat a more traditional Western diet, according to researchers at Columbia University Medical Center.

Researchers conducted a study in which 192 Alzheimerís patients were followed for an average of four and a half years. During that time, 85 of the people died. Researchers found that those who most closely followed a Mediterranean diet were 76 percent less likely to die during the study period than those who followed the diet the least. Alzheimerís patients who adhered to the diet to a moderate degree lived an average 1.3 years longer than those people who least adhered to the diet. Patients who strictly followed the diet lived an average of four years longer than those who did not.

A Mediterranean diet includes a high intake of vegetables, legumes, fruits, cereals, fish and monounsaturated fatty acids, a low intake of saturated fatty acids, dairy products, meat and poultry and a mild to moderate amount of alcohol.

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

2. Disease Management Q&A: Integrating Utilization and Mental Health Responsibilities

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's experts are Diane Flanders, director of coordinated care systems at MassHealth, and Sarah Keenan, clinical liaison with Medica.

Question:In considering care transitions, how have you managed and integrated utilization review (UR) responsibilities, and how is mental health managed in both of those situations? Are they provided through a separate program, or is the Senior Care Options program (SCO) or Medica care system responsible for that?

Response: (Diane Flanders) The UR responsibilities are within the organization itself. There are the classic mechanisms for sub-contracting, receiving and managing claims. They authorize those services, and then the claiming process is the way that they measure that. We made a big focus on mental health. Historically, this has been a real problem for seniors — them not accessing a mental health system — so we put a lot of work into this. For the non-elderly in Massachusetts we have a behavioral health contract, which serves people with mental illness and substance abuse in a variety of very creative ways. These can include partial hospitalization, day-care settings and community-based services that really arenít available in the traditional Medicare-Medicaid world. We just lifted those requirements and put them right into the package.

Now, all three of the senior care organizations have sub-contracted to varying extents with mental health companies so that they are purchasing that expertise. But we made a big point of saying that they needed to have their policies and procedures around that mental health fit in with a geriatric expertise, so that is part of the requirement, too. It is certainly a very important element, and something that weíre seeing an increase in utilization over what we see in fee for service. Thatís what we expected to see. Itís not very big at this point, but we think we should be seeing more services in that area.

(Sarah Keenan) The UR is done per care system, following the financial risk. It tends to be retrospective as opposed to prospective, and it varies per the care system. Certainly, most of those standard UR mechanisms would apply to this program as well. In terms of mental health, Medica contracts with a mental health vendor for their expertise. In this past year, weíve contracted with our Minnesota counties for the first time to do our care coordination. Itís added just beautifully to the expertise level, particularly on the mental health side, because of their relationship with their targeted mental health case managers. Itís opened the doors to so much information sharing, and weíve made great strides this past year on the mental health front. We have a long way to go, but itís really something that weíre seeing improvements in.

To get more information on mental health management for the dually eligible, please visit:

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

3. HealthSounds Podcast: Managing Transitions to Care for the Frail Elderly

In this week's Disease Management podcast, Dr. John Charde, vice president of strategic development for Enhanced Care Initiatives, and Laurie Russell, senior director of health solutions for XLHealth, explore how to create effective care management approaches for the frail elderly.

To listen to this complimentary HIN podcast, please visit:

4. Gene Abnormality Related to Early Onset of Parkinsonís Disease

People with a certain gene mutation are more likely to get Parkinsonís disease before the age of 50 compared to those without the gene abnormality, according to a study by Columbia Universityís Taub Institute for Research on Alzheimerís Disease and the Aging Brain, and Departments of Pathology and Neurology.

For the study, researchers analyzed the genes of 278 people with Parkinsonís disease and 179 people without the disease. The study found 14 percent of the people with Parkinsonís disease carried mutations in the glucocerebrosidase (GBA) gene compared to only five percent of people without the disease.

The gene abnormality was found in 22 percent of people who were diagnosed with Parkinsonís disease before age 50 compared to 10 percent of the people with disease onset after age 50. Mutations in the GBA gene cause Gaucher's disease, which is a rare disorder that prevents organs, such as the spleen and brain, from working properly due to the build-up of a fatty substance called glucocerebroside.

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

5. Disease Management: Definition, Benchmarks, Metrics

Although disease management (DM) is becoming a staple of many health plans, measuring actual dollar savings is still a goal not yet achieved, according to DM industry experts who spoke at an audio conference sponsored by the Managed Care Information Center (MCIC).

To download this complimentary white paper, please visit:

Please forward this news announcement to your colleagues who might find it useful.
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