Healthy Lifestylessm
Metabolic Syndrome Disease Management Program

What is Metabolic Syndrome?

Metabolic syndrome (also referred to as “insulin resistance, “syndrome X” and dysmetabolic syndrome) is a clustering of conditions that includes central obesity, hyperlipidemia, hypertension and insulin resistance. Together, this group of health problems increases the risk of cardiovascular disease, stroke, and diabetes.

Clinical identification of metabolic syndrome is made when three of the following criteria are fulfilled according to National Cholesterol Education Program (NCEP) Advanced Treatment Panel (ATP III) guidelines.

What Causes Metabolic Syndrome?

The cause(s) of metabolic syndrome continue to be explored. Known causes include genetic factors, as well as lifestyle practices that include inactivity, poor dietary choices, smoking and obesity (particularly abdominal obesity). This lifestyle can lead to insulin resistance and over time, the development of Type 2 diabetes, cardiovascular disease and/or stroke.

The Program

Using NCEP guidelines, Preferred Care has identified potential members (ages 20-70) who may meet ATP III criteria for participation is the Healthy Lifestyles metabolic syndrome program. Children and adolescents are not eligible at this time. Members with diabetes will be referred to the Preferred Care Take Control of Diabetessm program.

Program Participation

Member engagement and management focuses on primary care physician (PCP) referrals of patients to this program. Preferred Care may notify the provider of members who may meet criteria for referral, to promote program participation. Member self-referrals will generate a call to the PCP to determine eligibility. Members will not be contacted directly unless he or she self-refers or is referred by a health care professional.

Member Interaction

Our focus will be on facilitating member goal-setting, providing tools to assist in goal attainment, assistance with behavior modification and monitoring for metric improvements. Monitored metrics will include abdominal girth, cholesterol, blood pressure, depression (PHQ2/9), safety evaluation, and smoking cessation (if applicable).

Targeted education will focus on:

• Assessment / identification of metabolic syndrome
  • If a member does not meet the criteria for metabolic syndrome but may benefit from lifestyle modification, interventions will be reviewed with the member and appropriate referrals made to existing programs.
• Planning: member goal-setting and intervention negotiation
• Implementation: formatted to each member’s specific needs
  • Cholesterol management
  • Blood pressure management
  • Smoking cessation
  • Healthy nutrition
  • Exercise and activity
• Evaluation: lifestyle adjustments and modification
  • Identify and connect members with success-building resources
  • Ongoing evaluation / self monitoring
• Interactions will include positive reinforcement of appropriate behaviors.

Preferred Care will communicate with the PCP or referring health care Provider at the start and completion of the program and provide an initial and post-intervention Framingham Risk Score.

Improved Patient Outcomes

Motivated patients enrolled in this program are expected to show improved adherence to suggested dietary guidelines, positive lifestyle modification, and a reduced Framingham Risk Score (reflecting reduced risk of cardiovascular disease over the next ten years).

Providers are eligible for reimbursement upon completion of an enrollment form for each patient who:

• Meets program telephonic management criteria; and
• Successfully enrolls and engages in the program.

For more information about the Healthy Lifestyles Metabolic Syndrome Disease Management Program or to refer a member for enrollment, call Preferred Care Healthy Lifestyles program. Representatives are available Monday – Friday from 8:30 a.m. to 5:00 p.m. (Eastern Time) at
(585) 327-2465 or 1-800-933-3920, ext. 2465.

Last updated: May 8, 2007