American College of Physicians: Internal Medicine — Doctors for Adults ®

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A rich resource for diabetes education

From the January 1996 ACP Observer, copyright © 1996 by the American College of Physicians.

By William A. Check

Insurers and managed care organizations used to be reluctant to pay for diabetes educators and unwilling to reimburse physicians for time spent counseling diabetic patients on diet and exercise. Now this situation is slowly changing.

Ann Nettles, RN, MS, CDE, who works in a managed care setting handling disease management, introduces physicians and managers to non-physician resources such as dietitians and diabetes educators.

"A lot of payers don't know these resources are as rich as they are. They think of nurses as assistants in the clinic and dietitians as providing only an initial diet plan. As a result, these providers are really underutilized," Ms. Nettles says. She particularly recommends other non-physician providers for patients who need to learn additional expertise.

Ms. Nettles is a diabetes care manager in the division of therapeutics and outcomes management for Diversified Inc. in Minneapolis, a pharmacy benefits company serving HMOs and employers. Her responsibilities include applying conclusions from the Diabetes Control and Complications Trial and other diabetes research. "Prior to my arriving here, our clients were demanding this type of service," she says.

Some HMOs argue that savings from early diabetes care accrue later in life and that patients probably will no longer be in the HMO. But Ms. Nettles sees it differently. "I don't think diabetics will leave a good HMO," she says. "They are searching for good benefits, and I think we can prove that they are not a high turnover group."

Ms. Nettles conducts pilot projects in managed care situations. For example, she brings a cadre of diabetes educators to a site to show the difference they can make.

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