In an effort to meet diabetes screening targets set as part of a “pay for performance” contractual agreement with Harvard Pilgrim Health Care (HPHC), the BWPO and Primary Care created the Diabetes Outreach Program, which has led to significant improvements in the care process, according to Andrew Sussman, MD, BWPO chief medical officer.
In order to ensure primary care physicians met the targets that called for a 5 percent improvement in screening rates for diabetes testing (e.g. Hemoglobin A1C level checks), the BWPO set up a system that would ensure HPHC diabetic patients were contacted to encourage screening test completion. The medical director at each BWH primary care practice was asked to identify a diabetes outreach coordinator. The BWPO staff developed materials for the coordinators, including a form letter to send to patients needing additional testing. In addition, a letter was sent for patients’ eye doctors to ensure exams were coded correctly and results sent back to the PCP practice. All of this information was maintained in a BWPO-designed electronic database that enabled coordinators to track all of their patient contacts, record test results and track information gathered in the course of patient follow-up.
Other responsibilities of the outreach coordinators included reviewing patient records with PCPs, facilitating eye exams and other tests, such as LDL cholesterol testing and urinalysis for microalbumin, and entering all of the information into a specially designed database.
“We put the outreach program in place to meet risk targets set by contractual agreements,” said Sussman. “But the most important outcome has been our ability to identify patients who may have fallen through the cracks and were in need of important screening tests to help improve control of blood sugar, monitoring of cholesterol levels and facilitate the performance of eye exams and urine protein monitoring.”
As a result, the BWPO met the targets in 2001, thereby allowing for return of the BWPO physician withhold that was at risk based on these diabetes measures. The PO has improved upon its compliance rate in each of the four areas specified in the contract, with some BWPO screening rates jumping more than 15 percent. The screening standards utilized were those outlined in the Health Employer Data Information Set (HEDIS), used by insurers to measure screening quality.