Overcoming the Barriers to Innovations in Diabetes Care
Disruptive interventions aimed at preventing diabetes are efficient and cost-effective ways to improve patient care, according to a new report, which warned institutional, regulatory, and financial barriers impede the widespread implementation of innovative treatments that would curb rising healthcare costs associated with treating the chronic disease.
The case-study review included diabetes treatment innovations implemented in India, Mexico, and the United States that ranged from advanced systems backed by substantial resources to low-cost solutions for identifying patients with diabetes who are not being managed to effective outcomes.
In the United States, for example, the YMCA Diabetes Prevention Program is a community-based initiative that combines exercise, health education, nutritional coaching, and individual counseling during 16-week sessions. According to the report, half of the 300 initial participants in New York lost over 5% of their body weight and maintained the weight loss for a year. The authors noted that the initiative has lower administrative costs and shorter session lengths than the Diabetes Prevention Program (DPP) on which it was based.
Unless a cure for diabetes is found, innovations that prevent and treat the disease are needed. But disruptive treatments aren’t reaching the patient populations that would benefit most, according to the authors, who called overcoming the barriers to widespread implementation an “urgent priority.”
New models of care often don’t mesh with existing payment policies, making funding difficult, noted the report. It stated that even though the DPP estimates nationwide implementation of the program would delay 885,000 new cases of diabetes and result in $5.7 billion in savings over 25 years, the Centers for Disease Control and Prevention (CDC) and the Department of Veteran Affairs don’t have easy ways to redirect funding to support such an undertaking. The authors noted that private insurers have supported the program, but still need grant support from the CDC to fully fund it.
Accountable care organizations (ACOs) are fully integrated health systems where caregivers are mandated to achieve set outcomes for specific patient populations over a certain time period and for a standardized cost. The ACO model moves away from fee-for-service payment models, instead basing reimbursements on measurements of value. According to the study, ACOs could increase financial support for community wellness programs, self-management tools, and for providers who participate in coordinated care, ultimately leading to more cost-effective treatment options for diabetes.
Diabetes impacts 11% of Americans, and failing to treat risk factors such as coronary artery disease and renal failure drives up the medical and social costs associated with the chronic disease. The authors said how effectively healthcare systems treat diabetes could provide an indicator of the nation’s capacity to control the burden of other chronic illnesses.
“To change the model of care delivery for diabetes, there has to be new kinds of data sharing at the patient level,” said study co-author Dr. Mark McClellan, a senior fellow and director of the Health Care Innovation and Value Initiatives at the Brookings Institution in Washington, D.C.
One of the advantages of working to improve the treatment of diabetes is that outcome measures are relatively well defined, pointed out Dr. McClellan. “We have short-term predictors of long-term complications and very good evidence-based measures of screening and behavior changes, as well as medication treatments that are clearly responsible for improvements in outcomes,” he commented.
For countries or healthcare systems attempting to assess the impact of disruptive innovations on the treatment of chronic illnesses, said Dr. McClellan, “diabetes isn't a bad place to start.”
Type 2 diabetes is on the rise throughout the world and there are many new examples of solutions that provide care in low- and middle-income countries, noted study co-author Dr. Krishna Udayakumar, the head of global innovation at Duke Medicine in Durham, North Carolina. He added, "These models can address a critical health challenge and also serve as inspirations to health-system leaders in higher income countries as they imagine how to better care for people with chronic illnesses at lower costs."
The study was published in the journal Health Affairs.
—Dan Cook
Reference:
1. Thoumi A, Udayakumar K, Drobnick E,Taylor A, McClellan M. Innovations in diabetes care around the world: case studies of care transformation through accountable care reforms. Health Aff (Millwood). 2015;34(9):1489-1497.
