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CDC Data Show How Managed Care Missed Opportunities With New Diabetes Cases
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A new study shows only a small share of patients with private insurance who were newly diagnosed with diabetes in 2011-2012 enrolled in self-management training, raising questions about how well managed care could address both long-term health and cost control for this important group. These patients are a target for special attention under the ACA.
Helping patients with diabetes mellitus learn to maintain glycemic control is important, both for improving their long-term health and for controlling costs. So why did so few newly diagnosed patients with private insurance enroll in diabetes self-management training?
Findings released yesterday from the CDC for the years 2011-2012 are a cause for concern, both for patient health and for bottom lines. Diabetes care is a key focal point for accountable care organizations (ACOs), which are subject to new Medicare reimbursement formulas under the Affordable Care Act (ACA).
Yesterday’s study, part of CDC’s Mortality and Morbidity Weekly Report, examined records of 95,555 newly diagnosed persons with diabetes. Of these, 25.6% were not prescribed any antiglycemic medications, and 6.8% were prescribed insulin, with or without oral medication. During the study period of 2011-2012, 6.8% of the newly diagnosed patients took part in diabetes self-management training within 12 months of diagnosis.
Using Marketscan data, CDC researchers found that participation rates were slightly higher among older patients, aged 45-64 years, compared with younger adults, aged 18-44 years (7.2% compared with 5.9%), and among those who received a prescription for insulin compared with those who received prescriptions for oral agents only (14.2% compared with 5.1%). Those in metropolitan areas were more likely to take training compared with those outside such areas (7.1% compared with 5.5%).
In their discussion of the findings, researchers expressed concern that among all subgroups studied, the highest level of diabetes self-management training was only 15%, even though this study involved patients with private insurance—in theory, a group for whom lack of insurance coverage should not be a barrier to participation. The study identified several potential barriers:
- lack of physician referrals
- personal perceptions about diabetes, including avoidance behaviors
- lack of awareness that diabetes self-management training exists.
Researchers warned that failure to participate in self-management training could reduce the likelihood that blood glucose remains well-controlled, which could lead to higher treatment costs down the line.
It is noteworthy that much has changed since the study period. ACOs now keep track of patients with diabetes, and many have specific programs in place to help those newly diagnosed understand the importance of managing their disease and maintaining glycemic control. The “diabetes bundle” has become part of the 33 quality measures tied to Medicare reimbursement. An ACO that allows its physicians to fail to refer newly diagnosed patients for self-management training would risk lower quality care ratings the following year.
In sessions of the ACO and Emerging Healthcare Delivery Coalition, an initiative of The American Journal of Managed Care, participants have shared new methods for helping patients manage their diabetes.
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