How do we Support Members with Diabetes and High Blood Pressure?

People who have diabetes are twice as likely to have high blood pressure. In fact, according to the American Diabetes Association, two out of three people with Type 2 diabetes also report having high blood pressure or take medications to manage their blood pressure. It is important to manage blood pressure to avoid developing other cardiovascular diseases.

HealthPartners looked at our data and saw that there is a wide disparity between white members and Black members on MSHO and SNBC when it comes to blood pressure control for people with diabetes. We are working to educate our members and clinicians about tools and resources to manage both diabetes and blood pressure.

What did we do to support our members with diabetes and hypertension?

HealthPartners worked to make sure that members are aware of all the routine tests they should be getting to monitor their conditions and send reminders when they are behind in getting them. We also worked to make our provider network aware of all the benefits our members are entitled to which can support them in keeping their conditions in control.

How did we reach out to members?

HealthPartners has an outreach campaign that encourages members with diabetes to get care from their clinician for many issues related to diabetes including A1C, nephropathy and eye exam. We updated this outreach to address BP control more effectively for diverse members.

• We conducted a focus group to learn what people like about our messages and what could be stronger. They made suggestions about what the letter looked like and who it was from, preferring a diverse nurse to a health plan Medical Director.
• Language was included about which diabetes management tests the member is due for and why it is important. Blood pressure monitoring was included for the first time.
• A full color postal mailing was delivered to members who don’t have an on-line account.
• We included resources for seniors and people with disabilities that are available from the plan including nurse support and on-line health coaching tools.

How do we collaborate with providers?

Home blood pressure monitors are a covered benefit for Medicaid members with a condition that requires daily monitoring, but this benefit is not widely known. During the pandemic when patients were not being seen in-person in the clinic home blood pressure monitoring helped clinicians track their patient’s blood pressure. Clinicians recognize this is a valuable tool ongoing to help their patients manage their own health.

• We educated our provider network about this benefit for Medicaid members by including this information in our provider newsletter, Fast Facts.
• We worked with our care group to identify members with diabetes who go to our HealthPartners and Park Nicollet clinics and whose blood pressure is not at goal. For these members, we worked with the clinic to obtain home blood pressure monitors for them.
• We identified key educational pieces to help patients understand the importance of blood pressure control with diabetes and to help ensure they take their readings correctly. We had these pieces translated into Spanish, Somali, Vietnamese, Cambodian/Khmer and Hmong.

We also educated care coordinators who work with our MSHO and SNBC members to help them understand the best tools and resources for working with members who have both diabetes and hypertension.

• MSHO members have access to supplemental benefits that are in addition to the standard benefit set. Many of these are health and wellness related resources that can directly benefit members with diabetes and/or hypertension. We educated Care Coordinators about these supplemental benefits so they would encourage their members to utilize them.
• In collaboration with other MSHO and SNBC health plans, we created a webinar series to educate care coordinators, clinic staff and others about tools to assist their clients with diabetes management. The webinars have included:
  • Meeting the Challenges of Diabetes: Consequences of Disease Progression
  • Food is Medicine – Integrating Effective Nutrition Interventions into the Healthcare System: A Concept Whose Time Has Come
  • Implicit Bias & the Pursuit of Health Equity
  • Oral Considerations for People with Diabetes
  • Diabetes and Skin Care

Social drivers of health such as food and housing access can directly impact a person’s ability to manage their health. HealthPartners implemented a new tool called NowPow to assist meeting the social and community needs of our members. It is available to staff at our health plan and clinics who work with members and patients, and can also be accessed by anyone who goes onto our website.

What challenges did we face?

Members and clinicians may not be aware of benefits that are available to them to help monitor and manage their diabetes and hypertension.

Clinics continue to be impacted by staffing shortages due to burn-out and leaving the profession, making access to appointments problematic. Some clinics are unable to fully support nurse-only blood pressure checks. This makes home blood pressure monitoring especially valuable.

MSHO and SNBC Care Coordinators are either nurses or social workers. Nurses typically have a better understanding of diabetes care, so educating social workers who work with members is important to help support our members with diabetes.

Results

It is too early in the project to determine the success of some interventions, such as the overall reduction in disparities between white members and Black members. However, we do have some preliminary success including the utilization of health and wellness supplemental benefits.

We monitor the success of outreach campaigns by how looking at how many members read the email sent, clicked through to find more information, and took the recommended action (we call this a conversion rate).

Results

HealthPartners is committed to encouraging our MSHO and SNBC members to receive support to manage their diabetes and hypertension. We will continue to send reminders to members to get all screenings and tests for their diabetes care. We will continue to work with clinicians to ensure that members who would benefit from home blood pressure monitoring have access to the tools and information they need.