Role of the Health Plan in Providing Support to Members With Diabetes




John A. Johnson, MD, MBA: On the managed care side, again, the part we play is to make the medications available. As I stated earlier, there are 12 different classes of oral antidiabetic medications. Insulin [is available] as an injectable medication, [and] the GLP-1s (glucagon-like peptide-1s) are also available.

You’ve got a lot of different medications available, so access to the medications is the part that we would play [a role in] as a health plan. Then, [as a health plan, we provide] wraparound support to augment the medical cocktail—meaning the disease management, the nutrition counseling, and the personal health coach, as well as the nurses that help with meal planning.

That’s how we play our role. If you look at both standards, whether it’s the ADA (American Diabetes Association) or the AACE (American Association of Clinical Endocrinologists), both start with lifestyle modifications. Both start with single-drug therapy. From there, it requires surveillance every 3 months to ensure that you’re checking the patient’s—our member’s—HbA1C (glycated hemoglobin). Again, getting that HbA1C to goal, which would be below 7 for the ADA and below 6.5 for the AACE, and monitoring for hypoglycemia, of course, [is important].

Our hope is that the provider community will use the guidelines that we make available on WellCare.com. [In addition], other managed care companies do the same thing. They have clinical practice guidelines that they make available, and those guidelines are used because they’re evidence-based—they’re connected to recommendations from the medical societies, from the CDC (Centers for Disease Control and Prevention), the NIH (National Institutes of Health), and all of the other approved entities in the United States. Just using those tools that are available [can] enhance the management of your diabetics.
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