The Case Studies:

ADULT ASTHMA INPATIENT ADMISSIONS - Reducing Hospitalizations With Better Outpatient Care
Description: To reduce the number of adult admissions related to asthma, this plan decided on a standard peak flow meter, added peak flow meter reading as a vital sign for patients with asthma and added education about the usefulness of peak flow meter readings to its adult asthma education curriculum.

ASTHMA DISEASE MANAGEMENT - Removing Barriers to Optimal Care
Description: After arranging members with asthma into three groups (based on severity), this plan entered members with more severe cases into an active case management program while expanding coverage to include peak flow meters and spacers. At the provider level, the plan distributed a new clinical practice guideline, and all primary care providers received profiles of their patients with asthma.

ASTHMA DISEASE MANAGMEMENT - Pursuing Patient Involvement
Description: In collaboration with a major pharmaceutical company, the plan developed and distributed patient profiles for patients with asthma, an asthma care kit and a brochure outlining a step-care algorithm based on NHLBI guidelines. The result: decreased inpatient admissions and emergency room visits.

CORONARY ARTERY DISEASE - Supporting and Rewarding Improved Performance
Description: To reduce the prevalence of heart disease among its members, this plan distributed revised clinical practice guidelines, developed outreach efforts for members at risk for heart disease and added LDL cholesterol measures to its incentive program for medical groups.

DIABETES CARE MANAGEMENT - Aggressive Interventions Leading to Incremental Improvement
Description: After working with focus groups comprised of key stakeholders to identify barriers to care, this plan presented physician forums (for continuing education credit) and health risk appraisals for members. These efforts were followed by mailings to members with diabetes.

DIABETES CARE MANAGEMENT - Broad Improvement Across a Set of Comprehensive Measures
Description: As part of a statewide effort at improving diabetes care, this plan mailed members reminders about the importance of diabetic retinal examinations, followed by the introduction of an automated reminder system at participating pharmacies. The plan supported these member education efforts with continued communication via the member and provider newsletters, and the development of a health assessment tool for new enrollees.

DIABETES CARE MANAGEMENT - Putting All the Pieces Together for Diabetes
Description: This plan sought to improve its performance in five key areas of diabetes care by hiring a certified diabetes nurse educator to coordinate diabetes care, designing assessment tools for specific outcomes and distributing a diabetes flow chart, used in tracking individual patient care, to primary care providers.

DIABETES MANAGEMENT PROGRAM - Improving Multiple Aspects of Diabetes Care
Description: At the member level, the plan targeted members with diabetes with a letter stressing the importance of regular eye examinations. The plan also issued revised practice and referral guidelines and implemented four new diabetes-focused performance measures.

DIABETIC RETINAL EXAMS - Education, Reminders, Cost and Convenience
Description: The plan refined its system of tracking members not seen by an eye care professional in the past year, increasing each medical office's patient outreach from quarterly to monthly. The effort was supplemented by member newsletter articles and diabetes education classes offered several times per month.

DIABETIC RETINAL EXAMS - Keeping Improvement Simple
Description: The program's initial interventions focused on educating members and providers via newsletter articles and CME programs for primary care providers. The plan then made direct contact with primary care providers by providing lists of non-compliant patients, and with non-compliant members through letters urging them to request a referral for an eye examination.

DIABETIC RETINAL EXAMS - Managing Disease With Teams and Technology
Description: The plan began distributing patient-specific quarterly reports to physicians which contained information relevant to diabetes care, including the dates of each patient's last visit and last ophthalmology referral. Quarterly newsletters addressed topics relating to diabetes care.

DIABETIC RETINAL EXAMS - Repeating Member Outreach for Success
Description: This plan eliminated the referral requirement for eye care and collaborated with a new eye care vendor to improve member compliance; in addition, the plan sent targeted mailings to members with diabetes outlining the need for annual eye exams.

DIABETIC RETINAL EXAMS - Upfront Barrier Analysis Leads to Strong Interventions
Description: For this plan, direct mail was the primary tool for increasing rates of retinal exams among members with diabetes. Primary care providers received lists of patients identified as having diabetes and information on each patient's most recent eye examination; members with diabetes were mailed an educational brochure aimed at raising awareness of the need for annual eye examinations.

GLUCOSE CONTROL IN MEMBERS WITH DIABETES - Better Diabetes Care Through Technology
Description: Existing information services capabilities allowed this plan to create an online patient flow sheet, which listed key test results and dates. Another key plank in the plan's diabetes platform was the development of a diabetes care manager network, in which care managers were based in primary care areas of outpatient medical centers.

GLUCOSE CONTROL IN MEMBERS WITH DIABETES - Enhancing Care With a Team Approach
Description: The plan adopted an existing diabetes practice guideline, trained primary care providers and case managers in diabetes management and redefined the roles of each to foster a collaborative approach to care. In addition, the plan designed a diabetes registry that allowed patients with diabetes to be identified according to HbA1c level and assigned to a case manager based on their level of risk.

HIV/AIDS TREATMENT AND QUALITY OF CARE - Measuring and Improving Compliance With Practice Guidelines
Description: The plan increased its rate of compliance with HIV/AIDS guidelines by developing an HIV/AIDS treatment protocol manual and distributing it to providers. This was followed by various forms of education outreach, including newsletter articles, education seminars, a phone consultation service for providers and an HIV/AIDS health fair booth.

IMPROVING PEDIATRIC ASTHMA OUTCOMES - Systematically Strengthening Interventions
Description: Over a two-year period, this plan decreased pediatric hospitalizations and emergency room visits related to asthma, while increasing the appropriate use of anti-inflammatory medications. The effort sought to reduce barriers to care through a program of member and practitioner education.

PEDIATRIC ASTHMA - Refining an Effort With Annual Barrier Analysis
Description: To address access and education issues, this plan designed and implemented a wide-ranging series of initiatives, including coverage of spacers and peak flow meters, free copayment coupons to parents attending asthma classes, updated guidelines and physician education seminars.

SECONDARY PREVENTION OF CORONARY ARTERY DISEASE - Targeting Lipid Management With Strong Interventions
Description: To improve the care of members with a history of coronary artery disease, this plan sought to boost rates in three key measures of cardiac care: 1) low-density lipoprotein (LDL) measurement, 2) LDL control to less than 130 mg/dL, and 3) total cholesterol/high-density lipoprotein (HDL) ratio of less than six. To this end, the plan trained clinic staff on new care guidelines, while adding a more powerful lipid-lowering drug to the plan formulary. Patient tracking was also enhanced.

TREATMENT OF ACUTE SINUSITIS - Optimizing Antibiotic Therapy
Description: This initiative sought to optimize this plan's prescription of antibiotics to sinusitis patients. The intervention program reached providers through a clinical practice guideline, a drug evaluation program and mailings. In addition, the plan developed a targeted mailing for sinusitis patients and offered free educational materials to members.