Diabetes Programs

Diabetes Prevention

According to the CDC, 1 in 3 American adults have prediabetes. Additionally, more than 8 in 10 of these adults don’t even know they have it. Many people with prediabetes could develop type 2 diabetes within 5 years without taking action.

Risk factors for prediabetes include:

  • Being overweight
  • Age 45 or older
  • Having a parent or sibling with type 2 diabetes
  • Physical activity <3 times per week
  • Having birthed a baby weighing 9+ pounds
  • Having ever had gestational diabetes [1]

The diabetes prevention program is a covered benefit for most members if certain criteria are met. Contact Customer Service toll free at 1-888-327-0671 (TTY: 711) and ask to speak to your nurse if you would like to find out more information, to see if you qualify, or for assistance with locating a diabetes prevention program.

[1] CDC, National Diabetes Prevention Program, August 1 2023, https://www.cdc.gov/diabetes/prevention/about-prediabetes.html

Diabetes Disease Management

MHP utilization patterns have identified that Diabetes affects 2% of our population. Diabetes is in the top ten outpatient costs for services and is the eighth overall reason for Emergency care visits.

The Diabetes Management Program is a comprehensive program that begins with the early identification of the diabetic member, and through patient and PCP education, promotes improved outcomes. The basis for the program is the Taking On Diabetes initiative of the Michigan Association of Health Plans. The utilization coordinator targets the six core measures of diabetes.

  1. Hemoglobin A1c (BbA1c), done within the last 12 months
  2. A physical exam including a foot exam, done at least twice annually
  3. A dilated eye exam performed annually
  4. A lipid profile, including cholesterol, triglycerides and lipoprotein performed annually
  5. Patients should be advised to quit smoking annually
  6. Kidney Disease urinalysis done annually. If positive, treat the patient; if negative, conduct a micro albumin test. If evidence of pre-testing kidney disease (i.e., on Ace Inhibitors), urinalysis not required

In addition to the core measures, other aspects of care will be encouraged. These include:

  • Blood pressure monitored as a part of every physical examination
  • Influenza and Pneumococcal vaccines
  • Referral to a registered dietitian
  • Appropriate diabetes self-management education

PCPs receive notification of new members admitted to the program. Ongoing individualized contacts with the member are conducted on an as-needed basis to ensure understanding of treatment plans, promotion of the core measures and stabilization of the disease progression.

Members with a diagnosis of diabetes are automatically enrolled in the Diabetes Disease Management program. Members can become ineligible if they are incorrectly identified as diabetic, are no longer an MHP member (termed/expired) or if the member chooses to opt out of the program. For questions or to opt out of this program, contact Customer Service toll free at 1-888-327-0671 (TTY: 711).