Utah Diabetes Prevention and Control Program

To help meet the recommended standards of care for people with diabetes, the Utah Diabetes Prevention and Control Program convened a group of nine health plans to develop, implement, and evaluate care management strategies. The health plans matched members with diabetes to their most likely primary care provider and determined whether the members had received the recommended screening tests by using HEDIS measurements. Members received a personal profile of their screening test history and information on the recommended tests and their frequency, their health plan's policy for reimbursement for each test, and an incentive for getting an eye exam (e.g., a 60-minute telephone calling card).

This program has been consolidated with Heart Disease and Stroke Prevention Program and Physical Activity, Nutrition and Obesity Program to form Healthy Living through Environment, Policy, and Improved Clinical Care Program (EPICC).

The goal of this program is to help meet the recommended standards of care for people with diabetes in Utah.

After the program was implemented in March 2000, participating health plans collected HEDIS data on diabetes-related screening tests from 3,000 patient charts to evaluate the intervention. The results, although not exclusively attributed to the intervention, were significant. A1C testing for commercial and Medicaid plan members increased 12.5% to 86% and 1.5% to 79%, respectively. Commercial plans increased the percentage of patients with A1C levels below 7% to 33% (a 40% increase); the percentage below 8% increased to 53% (a 25% increase). For the Medicaid plans, there were also improvements in A1C levels among patients (by 19% for those below 7% and by 18% for those below 8%). The percentage of documented eye exams improved for both commercial (by 18% to a level of 47%) and Medicaid (by 5% to a level of 48%) plans.