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Lifestyle change hardest part of managing diabetes
Members are encouraged to take small steps
Prompting members who are at high risk for complications of diabetes to change their lifestyle to better control their disease is the hardest part of Fallon Community Health Plan’s diabetes program, points out Janice Betz, RN, senior clinical manager for diabetes care at Fallon.
Betz, the team leader for the Worcester, MA-based health plan should know. She has more than 20 years experience in diabetes management.
It’s essential for patients to take responsibility for their diabetes treatment plan and work to control their blood sugar by managing what they eat and how they exercise, says Joseph Cohen, MD, FCHP, associate medical director of disease management program.
“They have to understand that this is a disease they are living with and that there is no cure for it. They are going to die with diabetes and could die because of it, but if they take an interest in controlling diabetes, they’ll have better results and a healthier life,” Cohen says.
During their initial call to members in the high-risk disease management program, the health plan care managers try to determine whether the members have thought about making lifestyle changes and find out what changes they are willing to undertake, Betz says.
Of the patients in Fallon’s high-risk population, 90% have adult-onset diabetes and 80% of those are obese, Cohen says. All are at high risk for other health problems such as heart attack, stroke, and blindness.
“Diabetes affects every part of your body, rather than just one aspect. The toll on human lives and the people who take care of diabetics are tremendous. Patients can achieve control of their blood sugar levels by improving their behavior pattern, exercising, and losing weight. It can have a dramatic effect on their lifestyle,” he says.
Many of the members are not at the point where they are ready to change, Betz points out.
“A psychologist who consults with the diabetes program has educated the case managers on the stages of change, how the patients go through them, and what the health plan can do to help them become ready to change, she says.
The care managers encourage the members to take small steps that can add up to a bigger impact in the long run.
For instance, a member may decide to switch from sugar-filled soda to diet soda, a simple change that can have a big impact on blood sugar levels.
“It’s not our goal to change everything overnight. That is a setup for failure,” she says.
The company has set up an interactive voice recognition system that allows members to call a toll-free number and record their blood sugar levels verbally.
“Instead of having to touch numbers on the phone, they can speak their blood sugar levels. The system will automatically enter the blood sugar levels into an Internet-based application and generate an e-mail alert for the care manager,” Mlynaryk says.
The goal is for members to check their blood sugar levels seven times a day, something that rarely happens. The health plan care managers are pleased if the members enter pre-mealtime and post-mealtime readings at a reading at bedtime.
People in the high-risk group are encouraged to use the voice recognition system to call in their blood sugar levels every day.
The care managers explain to the members that it’s important to report their blood sugar levels, even when they are high, in order to help the health care providers manage the diabetes.
“Our goal here is self-management. It’s their diabetes and their health and we’ll do everything possible to empower our members to take control of their condition,” says Wally Mlynaryk, MHA, director of disease management for Fallon Community Health Plan.