Measuring Population Health, Meeting Individual Needs in Diabetes Care

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In its third year, Patient-Centered Diabetes Care, which took place April 16-17, 2015, in Boston, showed how new payment models, new therapies, and new approaches to patient engagement are changing care for persons with diabetes. The American Journal of Managed Care and Joslin Diabetes Center presented this year’s meeting.

This is the third year that The American Journal of Managed Care has presented Patient-Centered Diabetes Care, and the first in partnership with Joslin Diabetes Center.

The unique nature of this multistakeholder gathering gives payers the opportunity to network with every element of the healthcare delivery chain. "This is what is going to move us forward," said Robert A. Gabbay, MD, PhD, of Joslin Diabetes Center.

New payment models require better measurement of how well diabetes care is delivered, and both health outcomes and patient satisfaction matter. New therapies for diabetes make it possible to tailor treatment to individuals, but there are many considerations.

And new thinking on patient engagement means good care will require asking those with diabetes what they want, understanding their goals, and most of all, not blaming them for their diabetes. These are just a few of many lessons from the third annual multistakeholder gathering,Patient-Centered Diabetes Care, presented by The American Journal of Managed Care and Joslin Diabetes Center April 16-17, 2015, at the Renaissance Waterfront Boston.

Payment reform, especially the patient-centered medical home (PCMH), is driving innovation in diabetes care, said Robert A. Gabbay, MD, PhD, chief medical officer and senior vice president at Joslin. He praised the unique nature of the meeting, which gave payers an opportunity to network with every element of the healthcare delivery chain, including diabetes educators and patients. “This is what is going to move us forward,” he said.

Dr. Gabbay, who is also editor-in-chief of AJMC’s Evidence-Based Diabetes Management, used his keynote address to highlight how the PCMH is improving care for those with diabetes, by forcing attention to what happens in outpatient settings and requiring that actions be measured—including the quality of communication. “The first step in improving anything is to measure it,” he said.

Technology has brought solutions to longstanding problems, such as the shortage of endocrinologists and other specialists. Teleheath, eConsults, and systems that let endocrinologists “float” among many primary care practices are being tried, he said.

Population Health vs. Patient-Centered Solutions

The need to improve health measures of a group of patients—population management—is essential to meet federal requirements that reimbursement be linked to quality. But improving population-level measures can’t happen unless doctors and institutions meet the needs of individual patients. According to speakers and panel discussions at Patient-Centered Diabetes Care, that means ensuring patients have the right therapy, diet, exercise, and support network. The message: every patient is different.

Patrick J. O’Connor, MD, MA, MPH, senior clinical investigator at HealthPartners, said treatment decisions are driven by a patient’s age, the duration of disease, the number of medications, the level of adherence, the response to therapy, and whether there are complications. Each patient has difference preferences and levels health literacy, which affect the ability to deliver care.

For starters, some patients don’t think treatment will make a difference. Cultural attitudes can present barriers, too, he said. Thus, physicians are better off doing those things that patients understand. To make their points, physicians must make self-care solutions relatable, and they must not lecture. “Don’t heckle the patient about his disease,” Dr. O’Connor said. “Don’t blame them for it.”

Silvio E. Inzucchi, MD, professor of Medicine at Yale Medical School, offered strategies for selecting the right regimen from among 12 different classes of therapy now available for type 2 diabetes. Metformin remains the most common choice, given its low cost and lack of hypoglycemic effects. However, newer medications, such as DPP-4 inhibitors or GLP-1 receptor agonists, may offer additional benefits.

Dr. Inzucchi offered a list of considerations for prescribing diabetes medications, including the stage of the disease, the drug’s potency, what side effects are possible, what additional benefits it may bring, such as weight loss; practical issues such as the dosing schedule and whether it requires injection, and, of course, cost.

But “treatment” wasn’t all about medication. Patient-Centered Diabetes Care convened a panel with leaders in the type 1 diabetes social media movement, who provide education, social support, and instant feedback for device manufacturers. Frank Hu, MD, MPH, fresh from his service on the Dietary Guidelines Advisory Committee, discussed the role of nutrition in fighting diabetes and obesity and improving health. And a panel on delivery networks discussed how payers can put all the pieces together for the improvement of health.

The fourth annual meeting of Patient-Centered Diabetes Care has already been scheduled for April 7-8, 2016, in New York City. For information, see http://www.ajmc.com/meetings/pcdc16.

About the Journals

The American Journal of Managed Care celebrates its 20th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. Other titles in the franchise include The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care, and The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

CONTACT: Nicole Beagin (609) 716-7777 x 131
nbeagin(at)ajmc(dot)com
http://www.ajmc.com

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Nicole Beagin
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