Diabetes Program (Control for Life)

Chronic conditions such as diabetes can be difficult to manage. Neighborhood’s Disease Management team of nurses will work with you and your doctors to help you take care of your condition and to help you lead and health and active life. We will tell your doctor about your condition and how we help you stay well. We can also help with the environmental or social barriers you face that make it difficult to stay healthy

You may be eligible for the program

• If you are 18 years or older
• If you have been told by a doctor you have Type I or Type II diabetes

The goal of Neighborhood Health Plan of Rhode Island’s (Neighborhood’s) Control for Life Diabetes Program is to enable and empower members with diabetes to live, healthy active, lives, confident in their abilities to manage diabetes. Built on evidence-based practice guidelines, the diabetes disease management program is designed to reinforce the physician’s care and treatment plan through member outreach/ education, monitoring and management.

Neighborhood identifies members ages 18 years and older for participation in the Control for Life Program. Members are considered to have diabetes if claims data meets one or more of the following criteria in a 12 month period:

• The member was dispensed insulin and/or oral hypoglycemics and/or antihyperglycenics (excluding glucophage/metformin) during the past two years on an ambulatory basis and/or
• The member had two face-to-face encounters in an ambulatory or non-acute inpatient setting with a diagnosis of diabetes and/or
• The member had one face-to-face encounter in an acute inpatient or emergency room setting during the past two years with a diagnosis of diabetes

Note: Members with diagnoses of gestational diabetes, polycystic ovary syndrome, and steroid-induced diabetes are excluded from the population.

Member Resources

• Members in the Control for Life Program receive periodic mailings that contain educational resources and recommendations to assist them in better managing their condition. Topics covered include:
  • Importance of maintaining low blood sugar, through nutrition, exercise and weight management
  • Importance of screening lab tests and exams for members with diabetes
  • Need for regular physician visits
• Members identified as being at the highest risk receive telephonic outreach from a Diabetes Disease Manager. The Diabetes Disease Manager will discuss lifestyle issues that may exacerbate their condition, discuss self-management strategies, evaluate their status, review and discuss their responses to the Diabetes Knowledge Test and in general, monitor their condition and adherence to treatment goals. Click here for more details
• Diabetes outpatient educators and registered dietitians – Neighborhood covers the cost of education to help members better manage their diabetes
• Diabetes specialists
• Diabetes Knowledge test Q&A – do you know these facts about diabetes and nutrition?
• Are you overweight? Check the chart to find out

Provider Resources

• Neighborhood provides targeted physicians with actionable information derived from health plan claims and pharmacy data to support improved patient outcomes. Quarterly reports include
  • Detailed, member-level information summarizing received specific lab tests, screening or exams such as an A1c, LDL-C, dilated retinal eye exams, flu vaccine or have had a visit with their primary care physician
  • Aggregate site specific information summarizing A1c, LDL-C, dilated retinal eye exams, and flu vaccine.
• A Neighborhood Care Manager is available to support the primary clinician’s work to provide proactive, evidence-based diabetes care. .
• Guidelines for Diabetes Care
• See additional resources under Member Resources
• BMI calculator

Outcome Measurements and Effectiveness

We want to make sure that our Control for Life Program is effective in achieving improved health outcomes for our members with diabetes and in its delivery of services to our members and providers. Some of the key measures that Neighborhood pays attention to to assess the program include:

• HEDIS measure: Comprehensive Diabetes Care
• Member satisfaction with Neighborhood’s disease management services (annual survey / complaints data)