Managed Care - January 2009 - (Page 36)

Multifaceted Diabetes Program Pays Off for HealthPartners An aggressive approach produces much better outcomes and savings, to the tune of $15 million per year By Lola Butcher Contributing Editor years ago. It has come to be sponsored by six health plans in Minnesota, and 56 medical groups also participate. “Starting with ICSI, the marketplace moved away from the idea of competition being marketingrelated to competition based on a different approach,” Courneya says. “ICSI gave us the opportunity as a community to agree on the best practice. We agree how to treat diabetes, and then we compete on doing the best job.” Their consensus on what constitutes optimal diabetes care is managing a patient to achieve: • • • • • Blood pressure less than 130/80 mmHg Bad cholesterol (LDL-C) less than 100 mg/dl Blood sugar A1c less than 7 percent No use of tobacco Daily use of aspirin (ages 41–75) A t last, some good news about the costs of diabetes treatment: Patients who receive appropriate care ring up less than 10 percent of the medical costs of patients whose disease is poorly managed. That means a $5,000 annual medical bill for the healthiest diabetes patients, compared to $60,000 for patients who bounce in and out of the hospital with emergencies and complications. HealthPartners, a large health plan in Minnesota, is using that knowledge to improve the care — and health status — of diabetic members and save $15 million per year while doing it. Patrick Courneya, MD, medical director for delivery systems at HealthPartners Health Plan, prefers another set of numbers for measuring the insurer’s progress. “There are about 115 heart attacks that didn’t occur; 925 cases of diabetes-related eye disease that didn’t occur; 155 fewer amputations than we would have expected based on previous performance,” he says. “That is a very compelling argument to make to the physicians and care teams that are caring for our patients with diabetes, and it continues to propel more improvement.” Avoided problems mean dollars saved: $32,000 for heart attack, $12,000 for amputation, and $12,000 for stroke. Community support HealthPartners, with more than 1 million medical and dental health plan members, is the largest consumer-governed health plan in the country. Courneya, trained in family medicine, describes ways in which the plan approaches care for diabetic members. HealthPartners and three large provider groups founded a quality collaborative called the Institute for Clinical Systems Improvement (ICSI) about 15 The components have come to be known as the “D5,” and another community organization that HealthPartners and other insurers helped start — Minnesota Community Measurement — operates a Web site (www.thed5.org) that tells patients which medical clinics have the highest percentage of patients achieving optimal management of their diabetes. “The key is not just measuring those things, but actually having those things under control, and in order for a clinic to get credit, a patient actually needs to be under control in all of those five different parameters,” Courneya says. When clinics first started reporting, fewer than 4 percent of patients were under perfect control for their diabetes; today, the statewide average is 17.5 percent. Public reporting HealthPartners each year publishes a report on clinical indicators that documents the quality of care being delivered to its members. This year’s re- 36 MANAGED CARE / JANUARY 2009 http://www.thed5.org

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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