SECTION CONTENTS:

Putting DM Into Practice: Geisinger Health Plan
Reducing Fractures & Reducing Costs
“Make it easy to do the right thing”

Putting DM Into Practice: Geisinger Health Plan

The Geisinger Health System in Pennsylvania has the nation’s only NCQA-accredited disease management (DM) program in osteoporosis. The Geisinger Health Plan (GHP) Osteoporosis Disease Management Program is designed to improve the diagnosis, treatment, prevention, and outcome of patients with osteoporosis or at risk for osteoporosis. The program includes simple clinical practice guidelines, a bone density testing program, physician and allied health care education, and community education.

The GHP Osteoporosis DM Program was recognized by the American Association of Health Plans (AAHP) in 1999 as one of the top four best practices in women’s health in the country, and in October 2001, Geisinger received the 6th Annual Silver HERA Award at the National Managed Care Congress. Currently in its ninth year, the program continues to evolve to meet the needs of its members.

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Reducing Fractures & Reducing Costs

Since introducing the osteoporosis DM program in 1996, GHP has:

• Increased osteoporosis diagnosis by 400 percent
• Increased bone density testing by 1,000 percent
• Increased use of prescription osteoporosis treatment by 600 percent
• Decreased the hip-fracture rate by 36 percent
• Saved an estimated $7.8 million over a 5-year period by reducing the number of fractures

Between 1996 and 2000, the Geisinger osteoporosis DM team conducted a 5-year observational study of all women over the age of 55 enrolled in the Geisinger Health Plan, following established clinical guidelines that led health care providers to increase the evaluation of osteoporosis through bone density measurement and to increase the prescription treatment of the disease. Some women chose to participate in a formal osteoporosis education program; however, all women over age 55 received some level of intervention.

To determine cost analysis, a predictive cost model was developed to ascertain the expected costs if the osteoporosis DM program was not initiated – based on hip-fracture rates, medication use and BMD testing prior to the launch of the program. The predictive model was then compared with the actual cost: a net savings occurred if the savings for averted fractures was greater than the cost of increased BMD testing and increased medication use; a net loss occurred if the cost of increased BMD testing and increased medication was greater than the cost of the averted fracture.

This observational study suggests that an organized osteoporosis DM program delivered by a health care system can significantly increase evaluation and treatment of osteoporosis and reduce hip fractures, while at the same time decreasing the total direct cost of care to a health plan.

Study Results

• A significant decrease in hip fractures in women age 65 and older. This important outcome measure suggests that GHP’s program overall is showing significant success in altering the lives, in a positive way, of the people GHP serves.
  
  
  
  
• A significant increase in the number of women age 55 or older who are diagnosed with osteoporosis (from 5% to 20% over four years). This means that GHP’s doctors are more thorough at looking for osteoporosis than ever before.
• A significant increase in the number of men age 75 or older who are diagnosed with osteoporosis (from 1% to 4% over four years. This means that GHP’s doctors are diagnosing more older men who are also at increased risk of fracture.
  
  
  
  
• A significant increase in the number of bone density tests ordered throughout the system. DXA scans increased from 1,440 per year to 5,883 per year over four years. Heel ultrasound scans have increased from 1,188 to 2,949 over two years. This means that GHP’s doctors are searching more and more for those patients at risk for fracture.

GHP’s Evidence-based Guide to Prescription Osteoporosis Medications

• A significant increase in use of medicines to treat osteoporosis. This means that GHP’s doctors are prescribing more medicines that help reduce the chance of fracture.

Reference:

Newman ED, Ayoub WT, Starkey RH, Diehl JM, Wood GC. Osteoporosis disease management in a rural health care population: hip fracture reduction and reduction and reduced costs in postmenopausal women after 5 years. Osteoporos Int. 2003 Apr;14(2):146-151.

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“Make it easy to do the right thing” is the mantra that Geisinger follows and recommends for the implementation of disease management, according to Eric D. Newman, MD, Director of the Department of Rheumatology and Chair of the Osteoporosis Oversight Team.

A DM program can be hospital-based or clinic-based, but the leadership and staff must be willing and able to identify patients at risk, making sure these patients are tested and appropriately treated. Steps must be taken to assess patients who need treatment, not just to heal existing fractures, but to prevent future fractures.

GHP osteoporosis DM takes a systematic approach:

Employ a “Champion”

• A physician or nurse who has the passion and commitment to make the program work

Raise patient awareness through

• Physicians, nurse educators and allied health care providers
• Community pharmacists
• Local Department of Health Nurses

Educate physicians and allied health care professionals

• Comprehensive, concise guidelines (algorithm) for osteoporosis diagnosis and treatment
• In-depth information on prevention, safety, nutrition, secondary causes, bone density testing, medications and high-risk patients
• Dedicated osteoporosis GHP faculty presented over 30 educational sessions to more than 500 health care providers over the first two years

Facilitate appropriate diagnosis

• Identify at-risk population
• Combination of peripheral technology (heel ultrasound) and central technology (DXA)
• Four heel ultrasound machines rotated through approximately 25 Geisinger primary care clinics
• Uniform interpretation package developed for both heel ultrasound and DXA

Suppress barriers

• Identify and minimize the financial barriers to necessary testing and treatment

Measure outcomes

• Monitoring system to evaluate the bone health outcomes in the community involved
  

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