16 Del. C. § 3006T: Individual healthcare management plan [For application and expiration of this chapter upon fulfillment of contingency, see 85 Del. Laws, c. 453, §§ 2, 4].

The physician-led healthcare team for each patient participating in this Delaware Diabetic Wellness Pilot Program (Pilot Program) must establish an individualized healthcare management plan for their patients. Admission to the program will be limited to those patients with a hemoglobin A1c range including 6.5% to 10.0%. This plan must, at a minimum, assess the following: weight: overweight or obese; diagnosis of diabetes; assess blood pressure control; asses blood lipids; assess cardiovascular health and measuring: waist circumference, fasting glucose, blood pressure, fasting insulin level, hemoglobin Alc, lipid panel to include: total cholesterol, HDL, LDL, cholesterol to triglyceride/HDL cholesterol ratio level, high sensitivity C reactive protein, vitamin D level, urine albumin to creatinine ratio (UACR), vitamin B levels for patients on Melformin, and magnesium level. Any RFP must specify these tests. Additionally, initial and regular consultation with dieticians who have completed topic appropriate lifestyle medicine training related to diet and food consumption will be integrated in an individual basis as directed by the physician-led healthcare team. Also tabulated and tracked, will be the number of primary care, specialty care, and emergency department/urgent care visits, and planned and unplanned hospitalizations.

All members of the healthcare team will be required to participate in lifestyle/functional continuing medical education (CME) to familiarize with the protocol requirements of this Pilot Program. The leaders of the Delaware healthcare system will specify course topics necessary to fulfill the education requirement.