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Talking with Payers, Providers and Patients About Diabetes:
An AAPPO Toolkit for PPOs
Tab 6: What Payers Can Do: Improving Management of Diabetes
Payers have a stake in ensuring that patients are treated effectively for diabetes: poorly treated diabetes results in more complications for patients, higher absenteeism, and higher medical costs. Payers can use disease management to improve care for patients with diabetes or they can leverage network physicians to improve the quality of care they provide. Leveraging strategies include pay for performance, Bridges to Excellence, NCQA recognition and other turnkey programs that are being used to reward physicians for better outpatient or hospital care. This Tab addresses disease management, while later sections address strategies for recognizing physician excellence.
Resources to share with payers:
NDEP “Making a Difference: The Business Community Takes on Diabetes” http://ndep.nih.gov/diabetes/pubs/MakingDifference.pdf
Talking Points to Make With Payers:
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Diabetes care requires a team approach centered on individual patient needs. A high quality diabetes care program includes eye exams, foot exams, and nutrition education. For example, standards of quality care for diabetes state that patients should have an annual eye exam to look for early (treatable) signs of “diabetic retinopathy,” a common complication.
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CDC research shows that diabetes disease management programs help patients reduce blood sugar, which is associated with a decrease in diabetes-related complications and death. Use of important screening and monitoring tests for diabetes care quality also increased for patients in disease management programs. The Center for Health Care Strategies examined research on the impact of a wide range of care management strategies in Medicaid programs, and found that disease management interventions reduced hospitalizations – the most costly type of care. http://www.chcs.org/usr_doc/Diabetes_
Studies.pdf
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Disease management programs are an organized way to improve care of patients with diabetes. Disease management programs identify patients with diabetes and reach out to them with information, motivational strategies, health coaching, and education designed to change behavior. Disease management programs are designed to save costs for payers and improve clinical outcomes for patients.
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Other models for improving diabetes care have emerged, including the Chronic Care Model and the Advanced Primary Care Medical Home. The key to better outcomes in any model is alignment of benefits, coordinating services (often through better information management), and engaging patients to be a knowledgeable and active partner in care.
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Copyright AAPPO April, 2008
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