The West Virginia Health Initiative Project
In 1998, after conducting an extensive study, a West Virginia gubernatorial
task force recommended that the state Medicaid Bureau implement
a disease management program rather than pursue a formulary. Elizabeth
Lawton, then Commissioner of the State Bureau of Medical Services,
acknowledged that savings would not occur immediately, but rather
would accrue over time, as patient health outcomes improved and
the need for emergency and other inpatient services decreased.
The West Virginia Health Initiatives Project (WVHIP), as the pilot
was called, was a joint undertaking of the West Virginia Department
of Health and Human Resources’ Bureau for Medical Services
and Bureau for Public Health, and the National Pharmaceutical Council.
It was designed to enhance the quality of diabetes care with the
following goals:
- Providing diabetes evaluation and education for patients, which
included a comprehensive assessment of the patient’s clinical
status, health care needs, risks, hygiene, and diet;
- Completing a drug therapy evaluation of each patient’s
oral or injectable medication requirements and their ability to
self-monitor blood glucose in order to recognize emergency conditions;
- Providing diet-management education, including education on
diet restrictions, eating patterns, and diet and medication interactions;
- Providing referrals to other providers to meet identified health
care needs, such as skin and wound, eye or renal care; and,
- Assuring use of a flow sheet and standardized Diabetes Assessment
Form in order to document a Comprehensive Diabetes Plan.
WVHIP used protocols, guidelines and educational materials developed
by the Centers for Disease Control (CDC) and the American Diabetes
Association (ADA). Program development included:
- Physician focus groups to determine knowledge of national diabetes
treatment guidelines established by the ADA and the CDC;
- Six standing-room-only, diabetes disease management training
sessions, led by physicians from the Cleveland Clinic, throughout
the eight county pilot area; 103 participants (physicians, nurses,
nurse practitioners, physician assistants, pharmacists), representing
90 multiple provider practices, or 169 PAAS (Physician Assured
Access System) providers, attended the sessions;
- Training and educational materials, which were later transferred
to CD-ROM so that providers who could not attend the actual sessions
had the opportunity to receive training;
- Analysis of Medicaid claims data for provider feedback reports;
and,
- Evaluation by the West Virginia University Center for Health
Care Policy and Research.
The total patient population for the pilot program was estimated
at 500 patients. An evaluation and review of sample patient charts
was conducted by the West Virginia University Center for Health
Care Policy and Research at eleven sites. The evaluation was based
on outcome and process measures. Cost measures could not be evaluated
due to the expense and complexity of obtaining matching data. A
sample of 15 patient charts per site was reviewed for a total of
161 chart reviews, demonstrating that the West Virginia Health Initiatives
pilot project had a positive impact on patient health and provider
behavior.
Evaluation results:
- Ninety percent of the providers interviewed changed treatment
of their diabetic patients and all reported that the program was
very useful;
- HbA1c lab tests increased from 60% to 73%, a 21.6% increase;
- Foot exams increased from 40% to 48%, a 20% increase;
- Lipid tests increased from 52% to 64%, a 23% increase; and,
- Physicians also reported doing more eye exams and monitoring
their patients’ nutrition.
Status: In July, 2001, state-wide expansion of the
pilot program was approved by the U.S. Department of Health and
Human Services’ Center for Medicare and Medicaid Services,
but, to date, the state has not begun implementation.
For more detailed information on the WVHIP including clinical
parameters and practice and provider interventions, please contact
Pat Adams, VP of Business Operations & External Affairs for the National Pharmaceutical Council,
phone (703) 715-2761.
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