|January 20, 2004|
Better Diabetes Control May be a Phone Call Away
NASHVILLE, Tenn.--Vanderbilt Children’s Pediatric Diabetes Program has been designated 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 enhanced 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 Pediatric Endocrinology at VCH. “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 that 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, the diabetes team at VCH will continue to see BlueCross members from all over the state, but BCBST will also encourage access to tools like telephone follow-ups and diabetic teaching, which will be covered by BlueCross to make sure the diabetic children and their families are making the best use of available resources to control diabetes.
Quick, easy, and frequent access to diabetes management information and advice is a key to allow families to optimize their child’s health, while leading a normal life. Blood sugars that are not well controlled can lead to later disability and generate substantial health care costs. 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 Vanderbilt Children’s diabetes program.
Care providers at the Vanderbilt Children’s diabetes program will be reimbursed for follow-up phone calls. Unlike a regular office visit, a phone call follow up will not involve any cost to the patient, there will be no co-pays, and phone calls that take place but do not meet reimbursement criteria will not be charged to the patient. Blue Cross will also continue to encourage and facilitate diabetes self-management education.
“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 provided the equivalent of a full time phone nurse who often takes up to 50 calls a day without reimbursement for that service,” Russell said. “We firmly believe that this service not only empowers families to manage their diabetes better at home, but also reduces utilization of hospitals and emergency rooms when children with diabetes become sick. In the long run, it reduces health care costs. 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.
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