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Diabetes Care Challenges Offer Hospitals Strategic Opportunities

Joe Cantlupe, for HealthLeaders Media, February 19, 2014

"A lot of people are challenged in their lives and may not be coming to appointments," Bluml says. "We've heard amazing stories: Patients have really gotten their diabetes under control and are trying to do the right thing with food choices; they are also making sure they are taking their medications. It's an inspiring thing that you are helping people in some portion of their lives through a team-based process."

The care features one-on-one patient consultations, group educational classes, grocery food tours in conjunction with certain markets, and exercise programs. Some of the patients also receive discounted or free healthy lunches at employer worksites and discounted copayments for medication and supplies.

Despite the promising results, a significant problem is the lack of reimbursements.

"We feel very strongly that our model works and have data to show that patients are healthier once enrolled in our program," Beatty says. "Unfortunately, there is not a reimbursement structure available to pay pharmacists to provide these services alone or any additional reimbursement from a standard office visit with a physician by having a team of healthcare professionals involved.

"This makes it very difficult to hire healthcare providers, such as pharmacists, even though it has been shown that patients are healthier when providers are working together as a team to care for the patient. This has been a limitation to expansion of our model to more patients with diabetes or other disease states," he adds.

Success key No. 3: Overcoming nonadherence

Providers are working to overcome a significant obstacle to improving the condition of diabetic patients: nonadherence to medication prescriptions.

"Nonadherence is probably the most common barrier we observe that leads to poorly controlled diabetes," Beatty says.

The Ohio State University Medical Center was involved in a study presented during the American Diabetes Association scientific sessions in 2013 that showed disease education programs can have a positive impact on hospitalizations. Sara J. Healy, MD, a soon-to-be endocrinology fellow at the medical center, presented data on patients hospitalized from 2008, with a discharge diagnosis of diabetes and glycated hemoglobin (HbA1c) levels greater than 9%. There was a 30-day analysis of 2,265 patients and a 180-day analysis of 2,069 patients. According to the study, readmission rates were 5 percentage points lower for those who received the education (11%), than those who didn't (16%).

Wendle, head of Main Line Health's education program, says medication adherence is an important concern. Years ago, she says, physicians would tell patients they had a slight case of diabetes or were borderline: "That means nothing. The statement now is prediabetes. I had a woman who came into the program, and she had taken it four years ago and had fallen off the wagon and came back. Some prediabetics have warning signs, while there others who don't have any symptoms and become complacent."

The availability and convenience of some smartphone apps allows patients to "have information at their fingertips when they are going to a restaurant and have a GPS for walking. These can be extraordinary motivators to see cause and effect," she says.

One patient came in for education counseling because she heard Tom Hanks announced he had type 2 diabetes, Wendle says, noting "whatever it takes."

As Beatty sees it, there are ways hospitals and physicians can overcome barriers that keep patients from controlling their diabetes, such as areas involving cost, motivation, diet, nutrition, and follow-up care.

Cost: If patients believe they have problems meeting expenses associated with improving care, they can work closely with the OSUWMC Department of Pharmacy medication assistance program technicians and pharmacists, who will help patients with the paperwork for the program at no cost. "This has a significant impact on patient access to treatment, in particular insulin and supplies," which can cost as much as $300 per month for patients, Beatty says.

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1 comments on "Diabetes Care Challenges Offer Strategic Opportunities"


Neal Kaufman (2/19/2014 at 11:13 AM)
This is a comprehensive review of ways that healthcare providers can improve outcomes for patients with diabetes. I would add that hospital should consider how to impact large numbers of people in an affordable way using HIT. Large scale population health approaches which are successful at an affordable cost are emerging. These approaches help individuals take control of their unhealthy behaviors so they are able to manage their risks and their chronic conditions. The challenge is to: Provide enough consumer engagement in an effective and targeted long-term intervention; Provide support at a cost that delivers a good and early return on investment without providing an undue burden on staff or on the individual. The most successful approaches are longitudinal interventions based on what is known to impact behaviors and self-management skills of the targeted population. Successful interventions are long-term, individualized, rich in content, and help participants set goals, monitor their performance, receive and provide social support, and find needed help from peers and coaches. Modern interventions capitalize on the power of information technology to provide cost effective interventions to large numbers of individuals by automating some or most of a patient's experiences to lower the cost, while maintaining fidelity to the proven approach. At DPS Health, we help our partners create a customized recruitment campaign and support service, which when coupled with our year-long, online transformation of the NIH's Diabetes Prevention Program, show clinically significant weight loss and positive ROI. Neal Kaufman, MD,MPH nkaufman@dpshealth.com www.DPSHealth.com