There is currently significant interest in the management of chronic conditions such as diabetes and asthma. Despite levels of control varying according to each individual, generally these people manage their condition successfully and live normal, productive lives. The CIGNA Health Management Programme is a private health-care service for employees that offers benefits both to them and their employer. The approach has been shown to have a positive impact on employee attendance and productivity.
Name: Helen O'Driscoll
Job title: Diabetes Care Specialist with CIGNA HealthCare
Has spent much of her career working in intensive care, including general cardiothoracic adult and paediatric units. She also has experience as an acute medical nurse.
2000: Started with CIGNA HealthCare on the private medical insurance (PMI) side as a utilisation management nurse.
2001: Started working in the health management role after attending CIGNA's parent company in the USA for two weeks' training to develop the product for the UK market. She is now a care specialist for the diabetes programme.
Qualifications: BSc Health Studies, RGN
The CIGNA Health Management Programme was launched in the UK in October 2003 for employers and employees and differs from other services available in the UK.
The programmes are designed to help employees manage their chronic condition and avoid situations that could lead to a medical crisis, while providing support and advice to help them become better managers of their condition both at home and at work.
The health management programme complements NHS services, with the CIGNA care specialists acting as advocates, and reviewing medical and health information with programme members. When doctors or diabetes clinics provide new reports, suggest new treatment options or prescriptions, the care specialist can be relied upon to help interpret results or explain anything that the member does not understand.
The programmes are also beneficial to employers by giving them a better understanding of their employees' health and well-being and, at the same time, productivity can be maintained, as the employee is helped to manage his or her condition. Costs related to absence and disability are thus reduced.
Membership of the programme for an employee typically lasts around 12 months, and the care specialist works with the employee to develop a care plan based on an assessment of his or her current condition and how it is being managed.
The initial assessment by the care specialist looks at employees' knowledge of their condition and at how confident they are about managing it. From the information so gained a care plan is compiled, from which the care specialist can note the appropriate interventions and degree of contact each employee will require while a member of the programme.
Members are issued with a health diary to help them keep track of clinical information between calls with their care specialist.
The company now runs three main health management programmes; for employees with diabetes, asthma or cardiac conditions. After piloting the diabetes programme over 12 months with a group of medical insurance clients the report revealed that there had been improvements in the group's blood glucose levels: they had dropped from an average of 9.7mmol/L to 6.9mmol/L, with a drop of 1% in average HbA1c levels from 8.5% to 7.5%.
Combined with my role as a diabetes care specialist is that of absence case manager. This is a telephone-based service to help employers manage employee absence using a dedicated team of highly qualified nurses and occupational health specialists. The absence case managers support absent employees while working proactively with them and their line managers to develop appropriate return-to-work plans.
The absence management service has been designed for large- and medium-size organisations, and works in conjunction with current human resources policies. It helps identify the causes of absence and informs management of the risks involved, the aim being to save costs and increase productivity.
Active intervention at the beginning of the absence period, with continuing follow-up, ensures appropriate treatment is identified. Ongoing medical and emotional support is provided, along with assistance in exploring return-to-work avenues or other alternatives.
Employees are managed throughout their absence. They are continually assessed, and contact is maintained with them and their employer. If appropriate, recommendations are made to the employer to assist an early return to work.
A TYPICAL WEEK FOR A CARE SPECIALIST
'As a diabetes care specialist I help employees manage their condition so as to avoid situations that could lead to a medical crisis. I combine this role with that of absence case manager. This is a telephone-based service to help employers manage employee absence using a dedicated team of highly qualified nurses and occupational health specialists.'
A typical week involves making a number of regular scheduled calls using each member's care plan as a basis for structuring discussions.
The first scheduled call was to a member who was being managed by the absence team due to recurrent kidney problems. She was subsequently diagnosed with diabetes and informed of the programme. She has been on the programme now for three months. During the call she voiced concerns regarding the medication she had been prescribed, which was causing side-effects. We discussed this at length and I provided reassurance, and arranged to send her further information. I scheduled a further call for one month's time when we would discuss another topic from her care plan.
I had two other scheduled calls in the afternoon, and these involved working through their care plans. I arranged to send further information to both individuals.
Later, there was a call from a client's mother who had diabetes. I was able to give general advice and point them both in the right direction for more help.
I spent the day off-site visiting an absence client to discuss the progress of the current caseload.
My first scheduled call was to an employee who has been on the diabetes programme for six months. She had been to the diabetes clinic and had been told that her clinical measures had improved, so I now put her on a lower intervention level. I also discussed the impact of a recent illness on her diabetes and how to control her diabetes in these circumstances.
My next call was to a young person who had been recently diagnosed with Type-1 diabetes and who was feeling overwhelmed by the diagnosis. I reassured her and helped her to understand what having diabetes will mean to her. I then made some 'absence' calls.
The first was to a woman who had been absent from work with scheduled surgery. She was now a week postoperative, and her wound had been giving her problems. I had discussed this in depth with her on a previous call and referred her back to the specialist, who confirmed she had an infection and started her on antibiotics. I was calling now to discuss the state of the wound, and gave her further advice. She was worried about returning to work, so I advised a phased return, discussed the hours with her and advised that I would call her on her first day back.
The next absence call was to a company's human resources department. An employee had been referred with problems with his back and the HR department wanted guidance on the condition.
I made further calls in the afternoon. In the evening I attended a lecture on the Disability Discrimination Act relating to staff absence.
In the morning I accompanied the sales team on a visit to a client to explain how the health management programmes work.
During one of my afternoon calls I 'graduated' a client from the programme. This happens once a member feels confident about managing his or her diabetes and clinical measures have stabilised within the recommended levels.
My next call was an initial assessment. These calls usually take about an hour. I assessed the employee's control of her condition and ascertained her knowledge of it so that we would be able to work together to develop a care plan.
I received a call from a female member with Type-1 diabetes who had recently joined the programme. Her blood glucose had been very high all night, and she had moved to a new area, so had not yet registered with a GP. She explained that when she had called a surgery for advice, the receptionist simply told her to call back to get an appointment. I advised her that I would call the surgery. I did so, explained the gravity of the situation, and arranged a GP appointment for her and advised that I would send the young woman round in a taxi.
I called the employee back and advised her to go to the surgery, from where she was admitted to hospital and discharged the following day.
On my next call to her we discussed the factors that had led to her hyperglycaemic attack so that she could avoid a repeat episode in the future.
The next call was to a male employee who enjoys running marathons. We discussed the best types of food he should eat to sustain him, the impact of exercise on his condition, as well as foods with a low glycaemic index.
Later, I called a gentleman with Type-2 diabetes. He had been prescribed a statin but did not feel it would benefit him. After I explained the rationale for his being prescribed statins he now feels a lot happier about taking them.
My last call of the day was to an employee with Type-1 diabetes. After our discussion she said that she now understood more about her condition and that she felt comfortable talking with me on the phone, adding that she feels her GP is able to spend only limited time with her.
This brings to an end another busy week. I find the role very fulfilling and enjoy being able to help and advise the members I speak to regularly.
The roles of a diabetes care specialist and an absence case manager
Diabetes care specialist
- Provides help and advice to employees to help them become better managers of their condition
- Develops care plans with employees, based on an initial assessment
- Employees generally remain on the programme for a year.
Absence case manager
- Runs a telephone-based service to help employers manage employee absence
- Supports employees while working with them and their line managers to develop return-to-work plans
- Works with human resource departments and their policies
- Continually assesses progress and maintains contact with employee and employer.
Further reading and information
Diabetes Control and Complications Trial Research Group. (1993)The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine 329: 14, 977-986.
Thoonen, B., and Van Weel, C. (2000)Self-management in asthma care. Professionals must rethink their role if they are to guide patients successfully. British Medical Journal 321: 7275, 1482-1483.