January 23, 2004

Controlling diabetes may be a phone call away with insurer’s pilot program

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Office assistants in the Division of Pediatric Diabetes Debra Meyer, left, and Cory Meyer (no relation) take calls from pediatric diabetes patients all over the state. The calls are directed to nurses or doctors who can give advice over the phone. Photo by Dana Johnson

Controlling diabetes may be a phone call away with insurer's pilot program

Vanderbilt Children’s Hospital’s Pediatric Diabetes Program has been chosen by BlueCross BlueShield of Tennessee as a Center of Excellence in a pilot program that will explore ways to keep children with diabetes healthier.

Diabetes can have devastating results if not kept in good control from the earliest days of diagnosis. The goal of this program will be to help patients effectively manage their diabetes through communication and education efforts, including telephone calls that extend beyond the traditional visit to the doctor’s office. Under this pilot project, those non-traditional efforts will be reimbursed by BlueCross.

“The ultimate goal is to empower these children and their families to learn how to make independent decisions about diabetes management while maintaining the best possible blood sugar control,” said Dr. William Russell, director of the Pediatric Diabetes Program. “We want to help them stay out of hospitals and out of emergency rooms and to grow up to be healthy, independently-functioning adults with diabetes. We fully anticipate this designation will help us reach that goal.”

Vanderbilt Children’s Pediatric Diabetes Program is one of the busiest in the country with 1,500 patients. The new Center of Excellence pilot will combine the skills of the diabetes specialists with the health management skills of BlueCross BlueShield of Tennessee.

Under the Center of Excellence designation, Vanderbilt doctors and nurses will continue to see BlueCross members from all over the state. It will also provide tools like telephone follow-ups and teaching sessions that will be covered by BlueCross to make sure the children and their families are making the best use of available resources to control diabetes.

Quick, easy and frequent access to information is a key for the families of children with diabetes in order to preserve all the body systems that can be damaged over time. Blood sugars that are not well controlled lead to blindness, amputation and even premature death in adulthood.

One of the greatest challenges in keeping all of Tennessee’s children healthy is getting the highest level specialty care to children who need it. Children who live in rural areas can have difficulty keeping diabetes in good control because it’s difficult to access programs like the Pediatric Diabetes Program.

Care providers at the Vanderbilt Children’s pediatric diabetes program will be reimbursed for up to 10 follow-up phone calls. Unlike a regular office visit, a phone call follow-up won’t involve any cost to the patient, there will be no co-pays, and phone calls that take place but don’t meet reimbursement criteria will not be charged to the patient.

Educational visits will also be reimbursed by BlueCross.

“This initiative is designed to enhance the physician’s effectiveness in managing uncontrolled diabetic patients,” said Dr. Steve Coulter, senior vice president and chief medical officer for BlueCross. “Reimbursing doctors to extend their services should not only improve the quality of health for patients, but also reduce total medical claims expenses.”

“It’s also important for us because for years we have had the equivalent of a full-time nurse who takes up to 50 calls a day without reimbursement for that service,” Russell said. “Reimbursement from BlueCross will ensure the telephone service can continue and even grow.”

The Centers of Excellence diabetes pilot initiative is part of the larger evidence-based medicine study now underway between Vanderbilt University Medical Center and BlueCross.

Evidence-based medicine is the application of scientific evidence and clinical experience used to determine the effectiveness of medical treatments and control costs.