HJNO May/Jun 2022

HEALTHCARE JOURNAL OF NEW ORLEANS  I  MAY / JUN 2022 49 Amy E. Himel, MD Medical Director, Utilization Management Louisiana Healthcare Connections ties with poor SDOH are profound. But by applying what we know about SDOH, we can not only improve individual and com- munity health, but we can also advance health equity — a priority for the Louisiana Department of Health as well as the Med- icaid Managed Care plans with whom they contract. n REFERENCES 1 Lin, J. ; Thompson, T.J. ; Cheng, Y.J.; et al. “Projec- tion of the future diabetes burden in the United States through 2060.” Population Health Metrics 16, 9 (2018). https://pophealthmetrics.biomed - central.com/articles/10.1186/s12963-018-0166-4 2 Zimmet, P.Z. “Diabetes and its drivers: the largest epidemic in human history?” Clini- cal Diabetes & Endocrinol 3, 1 (2017). https:// clindiabetesendo.biomedcentral.com/arti- cles/10.1186/s40842-016-0039-3#:~:text=Conclu- sion,rise%E2%80%9D%20of%20type%202%20 diabetes 3 Louisiana Dept. of Health. “Diabetes and Obe- sity Report for the Medicaid Managed Care Pro- gram.” Feb. 2021. https://ldh.la.gov/assets/docs/ LegisReports/Act_210_Diabetes_Obesity_Re- port_FINAL.pdf 4 Vijayaraghavan, M.; Jacobs, E.; Seligman, H.; Fernandez, A. (2011). “The Association Between Housing Instability, Food Insecurity, and Diabe- tes Self-Efficacy in Low-Income Adults. Journal of Health Care for the Poor and Underserved 22, 4 (2011): 1279-91. https://www.researchgate . net/publication/51789395_The_Association_Be- tween_Housing_Instability_Food_Insecurity_ and_Diabetes_Self-Efficacy_in_Low-Income_ Adults 5 Hill-Briggs, F.; Adler, N.E.; Berkowitz, S.A.; et al. “Social Determinants of Health and Diabetes: A Scientific Review.” Diabetes Care 44,1 (Nov. 2, 2020): 258–279. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC7783927/ ANewOrleans native and graduate of Louisiana State University (LSU),Amy Himel,MD, is board certified in internal medicine.With a focus on hospital medicine and hospice care, Himel also serves as a relief hos- pitalist with East Jefferson General Hospital in addi- tion to her role as UMmedical director for Louisiana Healthcare Connections. Prior to joining Louisiana Healthcare Connections,Himel was an assistant pro- fessor of medicine for LSU Health Sciences Center. Among numerous other topics, she has presented on tobacco cessation, adverse drug reactions, and hereditary hypercoagulable states.She is published in theJournal of the Louisiana StateMedical Society and is currently conducting research involving ongo- ing trials to assess the efficacy and safety of vaccines related to COVID-19. Intervention To help identify patients experiencing food insecurity, provider partners receive a “Food Insecurity and Referral Toolkit” that includes the Hunger Vital Sign two-ques- tion screening tool validated by Children’s HealthWatch and based on the U.S. House- hold Food Security Scale. Using an objec- tive technique to measure patients’ con- cerns about food and their access to food, providers ask the following questions: “Within the past 12 months, we worried whether our food would run out before we got money to buy more.” Was that often true, sometimes true or never true for you/ your household? “Within the past 12 months, the food we bought just didn’t last, and we didn’t have money to get more.” Was that often true, sometimes true or never true for you/your household? For those who answer “often” or “some- times” true, providers give them a food- bank referral that is specific to a local food- bank and promotes SNAP (Supplemental Nutrition Assistance Program) benefits they may be eligible to receive. Physicians then add the hunger-specific code — Z59.4 lack of adequate food and safe drinking water — to their claim. Including this code alerts Louisiana Healthcare Connections that this member would benefit from tar- geted outreach by a team of clinical social workers and certified community health coaches. Coordinated clinical care that also proactively addresses social needs means patients have a fighting chance in avoiding risk factors for chronic diseases like diabetes as well as healthier ways to better manage it. Today, anyone working in healthcare knows that the health gaps in communi- MULTIPRONGED APPROACH Education In that it requires self-regulation and monitoring by the individual, controlling diabetes is unique among chronic diseas- es, making patient-centered, culturally ap- propriate care through diabetes self-man- agement education and support key to meeting individualized goals for behavior- al change and successful, ongoing diabetes self-management. As part of its multipronged approach to diabetes prevention, treatment, and man- agement, Louisiana Healthcare Connec- tions deploys layered and complementary tactics designed to increase and improve member self-management. For example, certified diabetes educators ensure mem- bers are armed with better diabetes knowl- edge and self-care behaviors and, as a re- sult, experience reduced emergency visits and hospitalizations as well as improve- ments in their glycemic control. Outreach For members with outstanding annual diabetes screenings, Louisiana Healthcare Connections coordinates multi-chan- nel campaigns letting them know which screenings have not been completed. Di- rect mail, phone, email, and text are all used to communicate the benefits of pro- active care and promote earning rewards that can be used to pay utility bills, grocer- ies, phone bills, and more by members who complete their screenings. This targeted strategy combines outreach that supports clinical needs with incentives that help address SDOH ones. In addition, non-tar- geted and general diabetes education is provided at community events, through partner networks, and on social media.