Preventative care programs can help limit health system risk

In coming years, health systems will likely take on more risk for the health outcomes of their patient populations. If they are looking to prepare for the inevitable, support programs for Type 2 diabetes may be a good place to start.

Diabetes currently costs the U.S. around $245 billion annually in treatment, complications and lost productivity, according to the American Diabetes Association. On average, diabetics have medical expenditures about 2.3 times higher than they would in the absence of the disease.

Health insurers are turning to Type 2 diabetes interventions to manage their costs, and looking to pay physicians, nurses and hospitals to work with them. Medicare is also tracking how providers meet guidelines for diabetic seniors who are at increased risks of expensive cardiovascular events.

[See also: Population health solutions remain weak.]

Type 2 diabetes interventions have been tried and tested thanks to the landmark National Institutes of Health prevention program, and integrated delivery systems like Geisinger and Kaiser Permanente have been at work applying them in many communities. The challenge in managing population health is outreach and education — and getting patients to make lifestyle changes.

“It’s a many decade disease that contributes directly to heart attacks and strokes and for the majority of people leads to more and more complications and morbidity,” explained Thomas Graf, MD, Geisinger Health System’s chief medical officer for population health.

In the health system’s service area in central Pennsylvania, ”We had about 20,000 diabetic patients in 2004 and that increased to 28,000,” he said. “You’re never doing enough when the number of diabetic patients is up by 40 percent.”

Fortunately, Type 2 diabetes can be nipped in the bud at the pre-diabetes stage simply and effectively with interventions like dietary modifications and exercise. This is precisely what health systems like Geisinger, Kaiser Permanente and others are striving for in the way Type 2 diabetes is managed — the shift from chronic disease management to preventative care.

“It’s a team based model of care, based on nine quality metrics where the focus is on physician patient relationships,” said Graf. There are 3.5 that he specifically focuses on: “control of blood sugar, control of cholesterol, control of blood pressure, and the half is smoking, if they smoke, they need to quit.”

Across the nine state service area of Kaiser Permanente, “there are 600,000 members with Type 2 diabetes,” said Jim Dudl, MD, diabetes clinical lead with Kaiser Permanente's Care Management Institute. And, “the number has been growing by more than ten percent per year,” he noted.

With extensive electronic medical records, Kaiser Permanente has made a point of screening patients in an effort to prevent full-blown Type 2 diabetes.

Kaiser Permanente employs the A1C test as the standard for determining who is at risk for developing Type 2 diabetes and “that’s an A1C of 5.7-6.4,” said Trina Histon, senior principal consultant in clinical and operational improvement at Kaiser Permanente.“Our early learnings suggest members who have a higher BMI and A1C between 6.0 and 6.4 convert more rapidly to Type 2 diabetes.”   

“We feel the responsibility, ethically, that if they are in that risk range, that we want to let them know and we want to partner with them,” she said. Patients are then offered online and group education, as well as individualized education and coaching, to help them stick with eating and activity plans.

Preventing the conversion to full-blown Type 2 diabetes is an effort that must come from two sides: commitment to lifestyle changes from patients themselves and the guidance from healthcare workers trained in diabetes prevention. “It’s not going to be on medical care’s shoulders alone to address things like pre-diabetes, it really takes all of the components of how we live our lives — personal, community, and care delivery.”