Co-ordinated approach to treating diabetes leads to healthier outcomes for patients and medical scheme
Diabetes is a chronic illness that can impact not only a person’s physical health, but financial health as well. Ensuring that the disease is diagnosed and treated preventatively can help keep people suffering from the disease to stay out of hospital, prevent them from incurring expensive medical procedures and enable them to live full, healthy lives.
“Diabetes isn’t a condition that happens in isolation,” says Executive Principal Officer of Liberty Medical Scheme (LMS), Andrew Edwards. “When we look at treating people with the condition, we look at the person’s entire health risk profile and focus on the individual and their environment, rather than focusing on the disease in isolation.”
A diabetes disease management programme implemented by LMS demonstrates that when diabetics are assisted to better manage their condition through a process of education, monitoring and sharing information with doctors, their health can dramatically improve. “We’ve found that a personalised approach works best,” says Edwards. “This is a co-ordinated programme that has gone back to basics and focuses on primary healthcare.”
Caused by high blood glucose (blood sugar), either because insulin production is inadequate, or because the person’s cells do not respond properly to insulin, diabetes can lead to blindness, kidney failure, and nerve damage over time. Diabetes is also an important factor in accelerating the hardening and narrowing of the arteries leading to strokes, coronary heart disease, and other large blood vessel diseases.
“Treating diabetes alone can be dangerous as you have to consider a range of health indicators, such as blood pressure and other factors,” says Edwards. The LMS treatment plan covers regular visits to physicians, dieticians, podiatrists and specific blood tests that are required to monitor the disease. Edwards says: “Because diabetes can affect a person’s circulation, nerve sensation (feet going numb or tingly), skin health, and ability to heal wounds and fight infections, an annual foot exam is essential to detect problems early. Some patients require foot care every 2-3 months to avoid problems with their feet and closely monitor problems, so the programme covers the costs of these visits out of risk, not savings.”
And because diabetes is considered a lifestyle disease, members can make a huge difference to their health simply by changing their diet and lifestyle – such as exercising regularly. Each member is assigned an individual case manager from a team of disease managers – all registered nurses with primary healthcare qualifications. They conduct one-on-one consultations with each member on the programme and monitor their progress. “We look at the person’s risk profile and draw up an activity plan based on their current risk,” says Edwards. “This includes helping to educate the person about their condition and also liaising with their doctor to make sure the right tests are done and proper treatment administered.”
Patient feedback forms are designed to encourage doctors to treat patients comprehensively and holistically, and provide information which is used by the scheme to track the patient’s health. Diabetes is one of the conditions listed under government’s Prescribed Minimum Benefits (PMBs) and under law, treatment must be covered by medical schemes. “But it’s worth going further than the basic PMB package because we’ve found that investing in members staying healthy is good for the scheme in the long run,” says Edwards. The programme focuses on preventative care, which is funded out of the risk portion of a person’s medical cover and not their savings. Co-payments, where members have to pay out of their own pocket are also limited.
Edwards says that members have access to additional benefits such as more doctor visits per year than other members. The scheme also monitors if members have missed seeing their doctor or podiatrist in the past six months and reminds them to go for regular consultations. “An integral part of the programme is assisting members to spread their benefits throughout the year, so that they don’t land up at the end of the year having to pay out of their own pockets,” says Edwards. “By ensuring that problems are picked up earlier, we’ve seen individuals’ health improve and fewer overall hospitalisations as a result.”
