Managed Care Update

A Ruthian Approach 
To Diabetes

A similar thought comes to mind about the care of our diabetic patients. How we and other team members — these include the patient, managed-care organization, general practitioner and specialists — all work together determines whether the team, especially the patient, wins.

While managed care provides us with plenty of challenges, it can help us improve our game plan for the care of diabetic patients. To score a home run in your patient care, you’ll need to cover each of these bases.

Patients
Diabetic patients require a specific standard of care. Clinical guidelines are available from such organizations as the AOA (1-800-365-2219 or www.aoanet.org/cpg-3-cpdm.html) or the American Diabetes Organization (www.diabetes.org). 

Hopefully you already dilate all patients as part of your comprehensive exam. Even if you don’t, MCOs may expect you to provide this higher standard of care for your diabetic patients. The National Committee for Quality Assurance (NCQA), which accredits MCOs, keeps score of the quality of care each plan’s members receive. One measure it has relied on: The percentage of diabetic patients who receive annual dilated retinal exams.

Diabetic patients often require more frequent visits, and perhaps some extra coaching, than your other patients. Use your office computer to sort patients by diagnosis if your software has this capability, then pitch these patients on the importance of regular follow-up. 

In my practice, for example, we send a postcard that emphasizes eye health (we don’t mention the patient’s diabetes, since these postcards aren’t private). A staff member then follows up with a phone call. We also follow up with patients who don’t schedule an appointment on the first call, cancel their appointments or just don’t show up.

MCOs
Chances are the plan has some of its own rules when it comes to patients with diabetes. Although vision plans and PPOs don’t require referrals from the patient’s general practitioner, HMOs usually do. However, some plans now allow their diabetic patients to have an office visit and a dilated fundus exam without a referral. 

Check with the plan’s provider-relations representative. Meanwhile, let him or her know that you actively recall and schedule your diabetic patients. (Remember, early detection of diabetic retinopathy leads to better outcomes. Managed-care organizations like this, since it means cost savings and a better report card for them.)

General Physicians
Try sending a personalized letter to every internist, family practitioner and pediatrician in your area. Include those doctors who already refer patients to you and those who don’t. Let them know of your efforts to schedule your diabetic patients for dilated fundus examinations. 

Also send report letters about each diabetic patient to his or her primary care physician and copies to any other specialists the patient sees. This is especially important when caring for patients whose blood sugar is poorly controlled or who don’t see their GP regularly. 

When it comes to caring for diabetic patients, we are part of a larger team rather than in a league of our own. Communication with each team member makes for a winning game plan in which other doctors know we that provide excellent clinical care and help to achieve a successful outcome. The MCO achieves cost savings and a better quality rating. 
And, the patient still has a lifetime of vision, making this combination worth a lot more than a dime. 
 

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