Diabetes Disease Management Plan

Diabetes is a chronic disease that affects millions of Americans with serious, costly, and potentially fatal complications. To prevent or delay those costly complications, and to enable our Members with diabetes to lead healthy, productive lives, it is important that Capstone ensure these Members receive appropriate medical care (based on current standards of practice), self-management education, and medication and supplies needed to help control this disease.

This is accomplished through:

  1. Identification of Capstone Members with diabetes through the DDD diabetic study, claims review/report, authorization process, and ad hoc information.
  2. Monitoring services for identified Members with diabetes to assure Members are receiving appropriate services as determined by the American Diabetes Association practice guidelines.
  3. Telephonic interview with the Member/caregiver for obtaining information regarding Member's understanding of the diabetes disease process and understanding of services provided to Capstone Members with diabetes. Interview may include questions regarding the following topics:
    • General information regarding demographics (who Member lives with), cultural influences, type of diabetes, etc.
    • Physician visits (PCP, endocrinologist, podiatrist, ophthalmologist, dentists)
    • Diabetic education
    • Meal planning
    • Glycemic control (how the Member monitors blood sugars/symptoms and troubleshoots highs and lows
    • Medications
    • Activity level
    • Other risk factors (smoking, alcohol use, obesity, and other conditions including psychiatric disorders)
  4. Capstone monitors outcomes of diabetes control through:
    • Lab results (e.g., HbA1c, lipid panel, cholesterol profile, albumin, serum creatinine, urinalysis, fasting glucose, liver function tests)
    • ER visits
    • Hospitalizations
    • Weight and blood pressure management
  5. Follow-up reporting/feedback that may include communication with the Member, caregiver, physician, and ancillary providers to ensure appropriate coordination of care between the Member and their other care providers.
  6. Education materials available for Members on how to treat their disease and other available resources.

Capstone Health Plan