Medical Group Cuts Uncontrolled Diabetes By 29% In Less Than 90 Days

Medical group cuts uncontrolled diabetes by 29% in less than 90 days

Borgess Health employed an array of intensive patient engagement strategies, letting the data lead the way.
CHICAGO -- Cindy Gaines, a registered nurse, said it came as a bit of a surprise when leadership of Kalamazoo, Michigan-based Borgess Health (a member of Ascension Health) approached its medical groups in 2015 with a challenge: For the final quarter of the fiscal year, they were told to improve a quality metric of their choice by 20 percent.
It's rare for most health organizations to even attempt a 20 percent improvement in anything, even over the course of a year, said Gaines, vice president and chief operating officer at Borgess Medical Group, speaking at the HIMSS Pop Health Forum on Monday. Here they were supposed to effect a major turnaround in a critical chronic disease indicator in just 90 days?
Gaines and her colleagues chose to tackle uncontrolled diabetes, focusing on patients with hemoglobin A1c levels greater than 9. But it would be a challenge, to say the least.
"We're very good at taking care of the patient in front of us," said Gaines. "We're very episodic."
But "the real game-changer of pop health is suddenly I'm accountable for you even when you didn't come in front of me," she said. "Just because you haven't been in doesn't make me any less accountable for your care, which means we have to engage our patients differently."
The first step was to take a close look at at the information the medical group had at hand.
"In population health, one of the very basic foundational things you can do is start with the definitions," said Gaines. "Let your data ta Continue reading

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The HbA1C Test, Uncontrolled Diabetes + Mortality, Herbs For Diabetes

A recent analysis of National Health and Nutrition Examination Survey data (NHANES) found that older adults who had an HbA1c above 8% were associated with increased risks for all-cause, cardiovascular and cancer-related deaths.
What’s HbA1C?
The HbA1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The HbA1C test is sometimes called the hemoglobin A1c, A1c, or glycohemoglobin test. The A1C test is the primary test used for diabetes management and diabetes research. The A1C test can be used to diagnose type 2 diabetes and prediabetes alone or in combination with other diabetes tests. An A1C test below 5.6 % is considered normal and 5.7-6.4 % is considered pre-diabetic and above 6.5 is considered diabetic.
HBA1C And Mortality Rates
Adults aged 65 and older with diabetes were compared to those without the complicated disease. Searching for an association between HbA1c and mortality rates, Dr. Priya Palta, PhD, associate professor of epidemiology at Johns Hopkins School of Public Health, and her colleagues analyzed data from 7,333 adults aged at least 65 years participating in NHANES III (1988-1994) and continuous NHANES (1999-2004) and linked mortality data through end of 2011.
Of 4,729 adults who died over an average 9 year period, (1,262 from CVD, 850 from cancer and 2,617 from non-CVD/noncancer causes), patients with an HbA1c of 9% or higher were 8 times more likely to die from any cause compared with patients whose HbA1c was less than 6.5%. This was followed by all-cause m Continue reading

People with diabetes are facing rising prices for lifesaving drugs

Among treatments for chronic conditions, diabetes drugs aren’t nearly as sexy as, say, Sovaldi, last year’s breakthrough hepatitis C drug that offers a cure for the chronic liver infection at a price approaching six figures.
Yet an estimated 29 million Americans have diabetes — about 10 times the number with hepatitis C — and many of them will take diabetes drugs for the rest of their lives. Cost increases for both old and new drugs are forcing many consumers to scramble to pay for them.
“Every week I see patients who can’t afford their drugs,” says endocrinologist Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York.
Many people with diabetes take multiple drugs that work in different ways to control their blood sugar. Although some of the top-selling diabetes drugs, such as metformin, are modestly priced generics, new brand-name drugs continue to be introduced. They may be more effective and have fewer side effects, but these advantages often come at a price. In 2014 for the fourth year in a row, spending on diabetes drugs was higher on a per-member basis than it was for any other class of traditional drug, according to the Express Scripts Drug Trend Report. Fewer than half of the prescriptions filled for diabetes treatments were generic.
“The cost of diabetes treatment has been increasing pretty rapidly,” says Glen Stettin, senior vice president for clinical, research and new solutions at Express Scripts, which manages the pharmacy benefits for many companies.
Last year the cost of Humalog, a fast-acting insul Continue reading

USF Study: Inexpensive Drug Could Cut Type 2 Diabetes Cases By 30 Percent

According to the latest figures from the Centers for Disease Control and Prevention, more than 29 million people in the United States have diabetes – many of them the Type 2 form of the disease. That's where the body doesn't produce enough insulin on its own.
But another 86 million adults have prediabetes, with up to a third at risk of developing Type 2 diabetes within five years.
Now while experts say a change in lifestyle, with a healthier diet and more exercise, would cut that number down, so could an inexpensive, generic prescription drug called metformin - a drug that is currently being used by only 0.7 percent of patients with prediabetes.
Dr. Nicholas Carris, an assistant professor at the University of South Florida College of Pharmacy, recently co-authored a study looking at the cost-effectiveness of the drug in the Journal of the American Pharmacists Association.
(Note: You must be a member to view the full study.
Disclosure: Carris and his fellow authors have no conflicts of interest or financial interests in metformin or any other product or service mentioned in the article.)
Carris recently sat down with WUSF's University Beat to discuss the findings of the study. Here are some highlights:
What does metformin do?
"Metformin is our first-line medication actually to treat Type 2 diabetes and it's been studied also to prevent diabetes. It's a generic medication, it helps lower blood sugar.
"For people with prediabetes, it can also help them lose weight -- just a little bit -- and that was found out in the Diabetes Prevention Program research study, which is what Continue reading

Diabetes Medication Adherence Cuts Costs by 4%, Boosts Outcomes

For the 11.6 million commercially-insured patients using diabetic medications, this could produce a total savings of more than $210 million per year in medical and pharmaceutical costs while reducing long-term complications from the extremely common metabolic disease.
“Adherence to diabetes medications is critical not only for preventing the catastrophic consequences of the disease, but also for lowering total healthcare costs,” explains the report.
While adherence rates have increased slightly since 2014, only 63 percent of diabetic adults with commercial insurance were adherent to their drug regimens in 2016, Express Scripts found.
This relatively low number indicates a significant opportunity for pharmacists and healthcare providers to improve the way they educate patients, deliver medications, and foster continued engagement.
READ MORE: Medication Nonadherence Challenges 70% of Statin Patients
Payers spend more than $9000 per diabetic individual on medical expenses, which is close to triple what it costs to care for a beneficiary without diabetes. Those costs can rise drastically when patients do not have access to injected or oral medications, either due to financial hardship or behavioral issues.
Out-of-pocket drug costs for patients are on the rise, significantly complicating the issue. A quarter of patients are paying more for their drugs in 2017 than they did a year ago, says one recent survey, and 14 percent have skipped filling a prescription because they could not afford it.
Failing to fill prescriptions can have serious impacts on individual health as well Continue reading