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Volume 6: No. 3, July 2009

ORIGINAL RESEARCH
Readiness of US Health Plans to Manage Cardiometabolic Risk

Program Type Provide Program for the Community, % Provide Program for Clinicians, % Provide Program for Employers, % Provide Program for Members, %
Other 2.9 8.8 14.7 23.5
Insulin resistance 17.6 26.5 20.6 47.1
Glucose intolerance 17.6 47.1 44.1 58.8
High triglycerides 20.6 52.9 52.9 76.5
Hypertension 32.4 61.8 64.7 85.3
Cholesterol control 26.5 64.7 61.8 91.2
Physical activity 44.1 38.2 73.5 94.1
Nutrition 47.1 41.2 73.5 97.1
Obesity/overweight 50.0 41.2 70.6 97.1
Tobacco use 44.1 55.9 73.5 97.1

Figure 1. Percentage of health insurance plans with wellness, health promotion, or prevention programs/activities for members, employers, clinicians, and communities, by program type, 35 members of America’s Health Insurance Plans, United States, January 2008.

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Strategy Used by Health Insurance Plan, % Ranked as Among 3 Most Effective, %
Other 2.9 0
Disparities-reduction initiatives 58.8 0
Pharmacy consultation 52.9 2.9
Fitness classes 61.8 2.9
Community-based services 67.6 2.9
Nurse advice lines 70.6 2.9
Behavioral health programs for stress, depression, and/or substance abuse 73.5 2.9
Reduced co-pays/cost sharing 26.5 5.9
Drug therapy 61.8 5.9
Nutrition counseling 79.4 8.8
Tobacco use cessation programs 82.4 11.8
Health education classes 73.5 14.7
Web-based tools and resources 91.2 14.7
Patient educational materials/brochures 91.2 14.7
Physician counseling 35.3 17.6
Phone-based services 55.9 17.6
Worksite services 82.4 17.6
Incentives 76.5 23.5
Referrals to case management 91.2 29.4
Feedback from health risk assessment or appraisal 100.0 35.3
Health coaching 85.3 58.8

Figure 2. Percentage of health insurance plans that use strategies to help enrollees manage cardiometabolic risk and percentage of health insurance plans that rank the strategy as among the 3 most effective, by strategy, 35 members of America’s Health Insurance Plans, United States, January 2008.

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Strategy Used by Health Insurance Plan, % Ranked as Among 3 Most Effective, %
Disparities-reduction initiatives 35.3 0
Patient educational materials at provider offices 55.9 2.9
Referral to specialists 38.2 2.9
Incentives for e-visits, e-mails 14.7 2.9
Other 2.9 2.9
Specialized training for providers and/or their office staff 26.5 5.9
Consultation/referral to tobacco use cessation services 58.8 23.5
Pharmacy programs 64.7 23.5
Information technology tools to providers 52.9 38.2
Care coordination 79.4 38.2
Pay for performance 64.7 41.2
Feedback to providers 88.2 52.9
Evidence-based practice guidelines 97.1 55.9

Figure 3. Percentage of health insurance plans that use strategies to assist clinicians evaluate and/or manage enrollees’ cardiometabolic risk and percentage of health insurance plans that rank the strategy among the 3 most effective, by strategy, 35 members of America’s Health Insurance Plans, United States, January 2008.

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Barrier Named by Health Insurance Plan, % Ranked as Among Top 3 Barriers, %
Lack of performance measures 35.3 5.9
Lack of purchaser interest 23.5 5.9
Lack of guidelines 17.6 8.8
Lack of codes 26.5 11.8
Lack of evidence 14.7 11.8
Lack of provider interest 35.3 11.8
Lack of enrollee interest 61.8 35.3
Poor or unknown return on investment 55.9 35.3
Lack of reporting systems 79.4 41.2
Lack of enrollee-level data 73.5 44.1
Resources (staff, funds) 79.4 55.9

Figure 4. Percentage of health insurance plans that face barriers to addressing cardiometabolic risk and percentage of health insurance plans that rank the barrier among the top 3, by barrier, 35 members of America’s Health Insurance Plans, United States, January 2008.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


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