Minority populations in Georgia carry a heavier burden related to diabetes, as evidenced by the higher prevalence of diabetes and diabetic complications such as amputations, retinopathy and neuropathy. With the Hispanic population representing more than 5 percent and African Americans comprising approximately 30 percent of the state’s population, addressing racial and ethnic disparities in diabetes represents a health priority. Additionally, unlike their urban counterparts, 108 of Georgia’s 150 counties are rural. Rural counties typically have half as many physicians and dramatic shortages of nurses, therapists and nutritionists, straining the capacity of the health care delivery system to reach the residents that need care.
The primary goal of the initiative is to link rural residents with a Certified Diabetes Educator (CDE) who can offer culturally appropriate diabetes education tailored to the needs of African-American and Hispanic members in rural, underserved counties. Individuals take part in multiple one-on-one diabetes counseling sessions to support lifestyle changes and improve disease self-management.
Proxy race and ethnicity data methodologies were used to estimate demographic information for WellPoint’s diabetic members. Estimated race and ethnicity data were then used to identify rural regions with high proportions of minorities and low diabetes-related performance scores. For example, Figure 1 is a map of the percentage of African-American members with diabetes who had good HbA1c control, by county. The darkest shaded areas represent counties where 90 percent of members have poor control and therefore are regions of high opportunity for outreach interventions like the GPTH’s telemedicine network.
Figure 2 also demonstrates the ability to examine specific measures by racial/ethnic group by county to determine the greatest priorities for those areas. For example, in the Columbus market, the greatest opportunities for improving disparities lie in increasing African-Americans’ rates of good HbA1c and LDL control.
Since 2006, GPTH has begun to facilitate diabetes education for rural residents within approximately 30 miles of their homes by linking them with CDEs at a major medical center. After only a few months of implementation, the program is already at capacity with a lengthy waiting list.
WellPoint, Inc.’s Blue Cross Blue Shield of Georgia (BCBSGa) unit is seeking grant funding to partner with GPTH to expand the program and evaluate the efficacy of diabetes health education delivered through GPTH’s telemedicine network. Because government-sponsored health plans are the largest payers of telemedicine diabetic education services, recruiting CDEs who can provide bilingual or bicultural services to rural minorities appears to represent a very viable strategy for outreach. WellPoint, Inc. continues to consider opportunities for collaboration with public health centers and large rural employers with large minority populations (e.g., agriculture) to promote services.