McLaren pairs a diabetes prevention program with a disease management program that targets six core measures of care.
McLaren describes two diabetes offerings on one page: a prevention program and a disease management program. Employers should confirm which apply to their group.
What the program is and what members do.
What the program is
McLaren describes a Diabetes Disease Management program that begins with early identification of the diabetic member and promotes improved outcomes through patient and primary care physician education. The same page describes help locating a diabetes prevention program.
How members use it
For prevention, the carrier says to call Customer Service at 1-888-327-0671 (TTY: 711) and ask to speak with a nurse to learn more, see whether you qualify or get help locating a program. For disease management, enrollment is automatic.
What it covers or does not
McLaren lists six core measures: a hemoglobin A1c within the last 12 months, a physical exam with a foot exam at least twice a year, an annual dilated eye exam, an annual lipid profile, annual advice to quit smoking and an annual kidney urinalysis. It also encourages blood pressure checks, flu and pneumococcal vaccines, dietitian referral and self-management education.
Eligibility, funding and plan design.
Who can use it
The carrier says the prevention program is a covered benefit for most members if certain criteria are met. Members with a diabetes diagnosis are automatically enrolled in disease management and can opt out. The page does not state a line of business (Medicaid, Medicare or commercial). Employers should confirm with McLaren that it applies to their group.
How it is funded or sold
The page calls the prevention program a covered benefit for most members when criteria are met. It states no price for either program. We would ask what the criteria are before describing it to employees.
Where it fits in plan design
Disease management sits beside the medical and pharmacy benefits as a care support layer. The prevention program is tied to covered benefit status, so employers should check how it interacts with their plan’s cost sharing.
What to settle before relying on it.
Which criteria decide prevention program coverage?
McLaren says it is covered for most members if certain criteria are met. We would ask for the exact criteria and whether they differ by plan.
Is our group in the disease management program?
The page does not state a line of business. We would ask McLaren to confirm that members of our group are automatically enrolled.
How does the nurse line work for our members?
The carrier directs members to ask for a nurse through Customer Service. We would ask about hours, what the nurse can do and how members are told about it.
Common questions about this program.
Is the diabetes prevention program covered?
McLaren says it is a covered benefit for most members if certain criteria are met. Members can call Customer Service and ask for a nurse to see if they qualify.
What does disease management track?
The carrier lists six core measures: A1c, foot exams, an eye exam, a lipid profile, advice to quit smoking and a kidney urinalysis.
Does this apply to my employer group?
The page does not state a line of business. Employers should ask McLaren to confirm applicability to their group.
Where these details come from.
This page summarizes what McLaren publishes. Programs change, so confirm current details with the carrier before relying on them.
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