Horizon Blue Cross Blue Shield of New Jersey to embrace Matria's diabetes engagement model

Marietta 06 February 2001Matria Healthcare Inc. has reached an agreement with Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) to provide diabetes disease management services. The agreement spans the Horizon Health Management Organisation (HMO) and Medicare +Choice plans of Horizon Healthcare of New Jersey, Horizon BCBSNJ's New Jersey HMO subsidiary, covering over 230.000 lives and representing in excess of 12.000 diabetes patients.

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When it is fully implemented, the agreement is anticipated to generate approximately $4 million in incremental annual revenues for Matria. Matria revenue will be derived from fees paid for diabetes disease management services as well as revenues from the sale of diabetes supplies to participants. The programme began operations early in February 2001.

Frank Powers, President of Population Health Management for Matria, said: "A key aspect in the design of our diabetes disease management programme with Horizon constitutes the engagement model for programme participation. Under this model, all eligible members identified with diabetes, who satisfy agreed upon selection criteria, are included as programme participants unless they individually decline participation. The goal of our diabetes programme is to increase patient compliance with their prescribed plan of care and national guidelines, improve each participant's overall self-management capability, increase participant accountability for their own care and improve diabetes outcomes for participants, both clinically and economically. The engagement model for population-based disease management programmes will contribute to the achievement of our programme goals."

In this comprehensive diabetes management programme, eligible members identified with diabetes are identified and risk stratified to the appropriate level of care. Interactive health profiles are completed whereas supply and medication requirements are collected at enrolment and updated every six months. Participants receive proactive care calls at regular intervals. During these calls, each participant's compliance with provider recommendations and adherence to the diabetes self-care programme are monitored. In addition, members receive diabetes self-care education materials and have telephone access to diabetes patient education and a care management team which includes Certified Case Managers, Registered Nurses and Certified Diabetes Educators. Every 60 to 90 days, each participant is also contacted for supplies and medication re-orders.

Diabetes patients with advanced care requirements receive individualised care co-ordination designed to address each participant's compliance care plan, co-morbidities and/or behavioural issues. In addition to the services mentioned above, these participants receive additional collection and tracking of diagnostic data and condition-specific education and training. Based on the participant's condition and progress in his or her care pathway, a Matria case manager is in regular contact with the patient. Matria provides data management, outcomes analysis, as well as clinical and financial reporting to Horizon Healthcare of New Jersey.

David Bendich, MD, FAAP, Senior Medical Director, Quality Management Outcomes Measurement for Horizon Healthcare of New Jersey, commented: "Diabetes is a chronic condition with devastating effects when not managed appropriately. Proactive health management of all members with diabetes is paramount for successful diabetes outcomes. We wanted a programme that was not only proactive but also comprehensive enough to address all levels of diabetes patients, ranging from mild and moderate to those who require more intense intervention. In addition, we wanted to provide our members with a programme that supports the management of the participant's total health, not just the problems associated with diabetes. We believe that the Matria programme is able to meet these stringent requirements."

Parker H. Petit, Matria's Chairman, President and CEO, added: "We are pleased to establish this relationship with Horizon. Our goal is to keep people healthy and not just intervene when the patient's condition becomes severe. Matria and Horizon realise the value of proactive health management and the impact it can have on improving health outcomes. Programmes of this type are ideally suited for our TRAX system because it allows members who are at risk of diabetes to be identified. Appropriate clinical interventions can be managed through the TRAX real time environment."

Matria is a provider of comprehensive population-based disease management programmes, telemedicine services and fulfilment services to health plans and employers for women's health, and the chronic conditions of diabetes and respiratory disorders. Headquartered in Georgia, Matria has more than 40 offices in the United States and internationally. Horizon Blue Cross Blue Shield of New Jersey, with headquarters in Newark, is New Jersey's largest health insurer, providing coverage to 2.3 million individuals. The company has annual revenues of $4.5 billion. You can find more details on Matria's diabetes disease management activities in the VMW December 2000 article Matria and Medical Mutual of Ohio to partner in diabetes disease management programme.


Leslie Versweyveld

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