Lessons for Managed Care of Diabetes: Some Help Is Good, but Too Much Contact Confuses Patients

FOR IMMEDIATE RELEASE APRIL 13, 2014

Lessons for Managed Care of Diabetes: Some Help Is Good, but Too Much Contact Confuses Patients

PRINCETON, N.J. — Keeping persons with diabetes on track with medication and lifestyle modifications may require extra contact from health care providers. But these “touches” must be coordinated to avoid making patients confused.

These were two of the many lessons from the second day of “Patient-Centered Diabetes Care: Putting Theory in Practice,” sponsored by The American Journal of Managed Care at the Princeton Marriott at Forrestal. More than 125 attendees took part in the conference, which concluded Friday.

A lineup that included keynote speaker Robert Gabbay, MD, chief medical officer at Joslin Diabetes Center of Harvard Medical School, offered insights on how to strike the right balance between overlooking high-risk patients who skip medications and having too many “coordinators” from the many specialists involved in a diabetic’s life.

Among the lessons from Friday’s sessions:

• Evidence shows that getting patients to stick with therapy regimens, known in medicine as the issue of adherence, is a major challenge in treating persons with diabetes. But as the experts discussed Friday, the patient who gets too many phone calls may become frustrated, and some evidence shows that this can hurt adherence.
• The need for managed care to develop delivery models such as a Patient Centered Medical Home (PCMH), which in theory would coordinate care under one point of contact, will become more important. The nation is moving toward a reimbursement system that values whether patients are staying healthy, not how many procedures or tests a physician performs.
• Savings from preventive care may not be obvious or measureable for years, in contrast with short-term needs to meet financial targets or keep hospital doors open. This is a major challenge during this transitional period from fee-for-service to value-based reimbursement.
• Persons with diabetes need systems that are transparent, that put a proper value on a patient’s time, and find rewards for those who do a good job following treatment regimens.

Two patient advocates with type 1 diabetes, Amy Tenderich of the web-based news source DiabetesMine.com, and Rebecca Killion of McKenna Long & Aldridge, said navigating the healthcare system is more difficult than it needs to be. Both said if they struggle at times as highly informed patients, what is happening to those without education or insurance coverage? Ms. Tenderich perhaps best summed up the need for healthcare to adapt to its clients when she commented on the term “patient-centered.” Said Ms. Tenderich, “As opposed to what?”

Deneen Vojta, MD, of UnitedHealthcare said the next wave of healthcare advances will come on the “operations,” side, and she agreed with the patient advocates that change is overdue. ”We are too quick to blame the patients; we’re constantly talking about non-compliance and non-adherence,” she said. But when it comes to giving patients a voice in the decisions that drive their care, “I don’t think we do a good enough job with that. Patients are too often not front and center in creating their care plan.”

Dr. Gabbay, an expert on PCMH, said this is the best model for organizing a primary care practice. But, he cautioned, “It’s not a panacea. It’s not going to answer everything.”

He was among several experts who said it was impractical to offer intensive interactions for everyone with diabetes, but such efforts are essential for high-risk patients. The key, Dr. Gabbay and others said, is to harness the power of the electronic health record (EHR) to identify patients who have skipped follow-up appointments, failed to fill prescriptions, or whose glycated hemoglobin (A1C) levels indicate they are most at-risk of hospitalization or serious complications, such as kidney disease.

New payment models will reward clinicians who prevent downstream costs. “This is fantastic news for the world of diabetes,” Dr. Gabbay said.

“Diabetes care has always had to argue our value,” he said. Endocrinologists are poorly paid for the amount of care they provide, but Dr. Gabbay said a move away from fee-for-service will reveal their importance. “Now things are flipping around — we are now the answer to how to save dollars,” he said.

Other highlights of Friday’s schedule included:

• Healthcare economist Geoffrey Joyce, PhD, of the University of Southern California, offered an early look at a pilot program with the Centers for Medicare and Medicaid Services (CMS) that pointed up some conflicts within the move toward value-based care. The program, which utilizes pharmacists in offering more regular contact with poor, high-risk diabetes patients, has been so popular with doctors and patients that the insurer has vowed to continue it. But the program’s fate may fall on whether it saves CMS money, not whether health outcomes improve.
• Pharmacists can play a larger role in keeping diabetes patients on therapy regimens, as they have more regular contact and access to information a physician may not have.

About the Journal

The American Journal of Managed Care, now in its 20^th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. In December 2013, AJMC launched The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. Full coverage of “Patient-Centered Diabetes Care: Putting Theory into Practice,” will appear in an upcoming issue of Evidence-Based Diabetes Management, a news publication of AJMC.

FOR INFORMATION CONTACT: Nicole Beagin (609) 716-7777 x 131

Mary Caffrey (609) 716-7777 x 144

nbeagin@ajmc.com or mcaffrey@ajmc.com

www.ajmc.com