Mobile Technology: Improving People’s Lives by
Helping Manage Diabetes
Mark R. Fracasso MD, MBA, FACPE, Lavdena Orr, MD, FAAP & Karen Dale, RN, MSN
DC Chartered Health Plan, Washington, DC
As part of an overall quality improvement effort in the District of Columbia, D.C.
Chartered Health Plan, the oldest (25 years of service) and largest (over 100,000 members)
Medicaid managed care organization, launched a low cost and scalable health
improvement program using loaned mobile phones to help members improve their lives
through weekly text messaging to expand its case/disease management efforts.
Problem:
Self-Efficacy Scale:
Residents in the District of Columbia are affected at higher rates
for diabetes mellitus (DM) when compared to other areas of the
country. In 2010, 10.9% of the adults in DC received a diabetes
diagnosis whereas only 8.7% of adults nationwide carry this
diagnosis. Compared to whites, African Americans and
Hispanics are more than twice as likely to have DM. It is well
known that poorly managed diabetes leads to increased and
inappropriate utilization of acute care services as well as more
importantly increased morbidity with complications such as
blindness, kidney disease, loss of extremities, and earlier
mortality.
Sample Questions
Assessment of the problem, analysis of its causes:
Baseline data demonstrated utilization of emergency room
admissions was increasing for the organization at unsustainable
levels in 2011 with a rate of 900/1000 members compared to a
national average of 700/1000 members.
Using HEDIS reporting Eye, HbA1c, LDL-C, and Nephrology
tests for the Medicaid population, we recognized controlling
diabetes was not effective through the current processes with the
usual clinical provider visits. Based upon the many demands of
our clinicians, which limit the time spent with members,
particularly those with chronic conditions, we sought a new
model. Our new approach extends contact with the member by
providing health education and reminders. We also recognized
the improved success obtained by other organizations through
the use of text messaging specifically for pregnant women. Thus,
we believed that this low cost technology was scalable and its
results would be transferable for chronic conditions.
AIM:
The aims of this project were (1) Reduce unnecessary Emergency
Room visits (2) Improve HEDIS reporting for compliance (3)
Improve the lives of our members with diabetes.
Strategy for Change:
Selected the population - 40 individuals
Purchased the loaner phones
Developed the text messages
Self-Efficacy Survey conducted
Continued Engagement
Sample Text Messages
Category
Text Message Sent
Doctor
Visit your main doctor, foot doctor and dentist every three
months
Complication
Blood Sugars that are not controlled can cause your body
organs to stop working as they should
Disease
A normal blood sugar is between 70 and 125. A normal
HbA1c is less than 7
Talk to your doc before stopping your meds
Medication
Nutrition
Phone
You can eat delicious and healthy foods that are low in sugar
and good for your blood sugar
For questions call 202/ 408-3986
How confident do you feel that you can eat your meals every 4 to 5 hours every day,
including breakfast every day?
How confident do you feel that you can follow your diet when you prepare or share
food with other people who do not have diabetes?
How confident do you feel that you can choose the appropriate foods to eat when you
are hungry (for example snacks)?
How confident do you feel that you can exercise 15 to 30 minutes, 4 to 5 times a week?
How confident do you feel that you can do something to prevent your blood sugar
level from dropping when you exercise?
How confident do you feel that you know what to do when your blood sugar level goes
higher or lower than it should be?
How confident do you feel that you can judge when the changes in your illness mean
you should visit your doctor?
How confident do you feel that you can control your diabetes so that it does not
interfere with the things you want to do?
Improvement in Compliance - HEDIS Scores:
HEDIS Measure
Compliance March 2012
Compliance July 2012
Eye
3.1%
57.1%
HbA1c
6.3%
80.0%
LDL-C
3.1%
65.7%
59.4%
91.4%
Nephrology
Lessons learned:
1) Changing the paradigm provided substantial improvements in
HEDIS compliance. We are pending ER measures at time of this
reporting and follow-up survey reporting.
2) Engage members through an interactive approach whereby they
will have two-way interactions with the text messaging and
answering short questions.
3) Members need follow-up education on use of the technology.
Message for others:
1) We believe this program is a viable option for others to
emulate to reduce unnecessary ER visits, improve diabetes
management, and engage members toward improving their
health.
2) Do not simply limit this concept to diabetes but consider other
chronic conditions (HBP, Asthma, CHF, and high cholesterol) as
well as first three years of life with childhood vaccination
programs.
3) While Chartered provided loaner phones in other areas where
members have unlimited text plans the cost may be further
reduced through case managers/ disease managers enrolling
members using their phones for the text messaging.