New York State Diabetes Campaign Alexander Khodenko 2012

Khodenko 1

NYS Diabetes Campaign

According to the Center for Disease Control and Prevention (CDC), diabetes is the

seventh leading cause of death in the United States.1 This ranking is based on the 71,832 death

certificates in 2007 in which diabetes is listed as the underlying cause of death.1 Basing on death

certificate reports, diabetes contributed to a total of 231,404 deaths in 2007, the latest year for

which data on contributing causes of death are available.1 Diabetes is likely to be under-reported

as a cause of death.1, 2

Studies showed that only about 35% to 40% of decedents with diabetes

had it listed on the death certificate, and only about 10% to 15% had it listed as the underlying

cause of death.1, 2

Overall, prevalence of death among people of similar age and who have

diabetes is about twice higher than prevalence of death among people without diabetes.1, 2

Diabetes is a common, serious, and costly disease. In 2002, 18.2 million people or 6.3

% of the population were diagnosed with diabetes.2 In 2005, the prevalence of diabetes grew to

20.8 million people or 7.0. % of the population.3 As of 2010, diabetes affected 8.3 % of the U.S.

population which is 25.8 million people1, 4

(Figure 1). During 2005-2008 period, 35% of U.S.

adults aged 20 years or older had pre-diabetes based on fasting blood glucose level or A1C test.1

Projecting and applying this percentage to U.S population of 2010 yields an estimate of 79

million of adults 20 years and older who have pre-diabetes.1 According to data from the CDC

which monitored diabetes trends continuously since 1957, the number and the percentage of

population diagnosed with diabetes is steadily increasing.5 (Graph 1). Studies show that the

prevalence of diabetes in the US will continue to escalate.6, 7

The total number of people with

diabetes will surpass from about 11 million in 2000 to almost 26 million by 2025. By 2050, the

projected number of people with diabetes will rise to almost 29 million which is a 165 %

increase over the 2000 level.6 Diabetes is recognized as a public health problem of pandemic

Khodenko 2

proportions with staggering economic cost.6 Diabetes related costs in the US are steadily

increasing (Figures 2 & 3).

To reverse the diabetes epidemic, the New York State Health Foundation (NYSHealth)

took initiative and launched a $ 35 million, five-year Diabetes Campaign aimed at sustainment of

a comprehensive and coordinated care system as well as promotion of prevention measures.8, 9

As part of this initiative, the NYSHealth campaign is working with Healthcare Association of

New York State (HANYC) and other partners.1

In New York State, more than 1.8 million of residents have diabetes and its prevalence

is steadily rising (Graph 2 ).9 About 3.7 to 4.2 million of New Yorkers have pre-diabetes.

8 The

total cost for New Yorkers with diabetes mounted to approximately $ 8.7 billion, and lost

productivity costs of $ 4.2 billion.8, 9

The cost of health care for a person with diabetes is more

than five times as much as the cost for those without diabetes.8

In order to have a better understanding about how diabetes contributes to healthcare

costs in New York State, HANYC performed an analysis of New York health care utilization by

diabetic patients.8 The findings showed that more than half of emergency department (ED) visits

for people with uncontrolled diabetes resulted in hospital admissions; and more than 60 % of the

visits to the ED by patients with Diabetes Mellitus (DM) resulted in a hospital admission.8 The

percentage of hospitalization for DM in New York has risen by nearly 30% from 2000-2008.8

Basing on analysis of admissions, DM accounts for 84% of all admissions growth from 2000-

2008 period in New York.8 New York State residents who have diabetes are 1.6 times likely to

be readmitted to a hospital within 30 days after the discharge than patients without diabetes.8, 9

1 Partners: The Institute for Leadership, Bridges to Excellence, Community Health Care Association of New York

State, Health Care Association of New York State, National Committee for Quality Assurance, New York Chapter American College of Physicians, New York State Academy of Family Physicians.

Khodenko 3

Also, re-admission rates for patients with diabetes are higher across all payers.8 HANYC

analysis showed that Medicare patients are not receiving all of the screening tests that are critical

to managing diabetes and preventing complications.8 Only 39% of Medicare recipients received

all of the recommended tests, and 10% did not receive any tests.8

The data presented by HANYS, highlighted the urgent need to address diabetes as an

important and often hidden factor responsible for increasing health care utilization and costs.8

Based on recommendations by HANYS, New York State Health Foundation’ Diabetes

Campaign is supporting efforts to encourage and assist 3,000 primary care providers to improve

their care and obtain recognition under the following programs:

Health Care Payment

1) Provide Financial Incentives to Providers – establish well designed financial

incentive programs to providers for improving their diabetes outcomes. The

vision is that the more payers providing incentives for DM standards of care and

the more alignment among programs, the more precise the validation signals will

be to providers in regard to what is the most important in diabetes care. Providers

are expected to have greater motivation to implement practices that improve

outcomes in the delivery of care to patients with diabetes.

2) Emphasize Patient Outcomes in Financial Incentives Programs – establish

improved process measures (diabetes related screening: blood pressure and eye

exams) by including intermediate measures for diabetes (diabetes ABCs: HA1C,

blood pressure, and LDL Cholesterol) because they are the most tightly linked to

patient risk reduction in their incentive programs. The measures can be

demonstrated and verified by achieving recognition through the National

Khodenko 4

Committee on Quality Assurance’s (NCQA’s) diabetes Recognition Program or

Bridges to Excellence’s (BTE’s) Diabetes Recognition Program.2

Health Care Delivery

1) Ensure the Adoption of, and Adherence to, Evidence-Based Clinical Practice

Guidelines – adoption of, and adherence to, clinical practice guidelines is

envisioned as critical to improvement of diabetes outcome. Many hospitals

and clinics use a variety of strategies to monitor outcomes of diabetes.

Recognition under the NCQA and BTE programs also enables health care

organizations and providers to assess, improve, and monitor their diabetes

outcomes.

2) Support Diabetes Self-Management Education (DSME) – based on studies,

diabetes self-management education can improve outcomes for people with

diabetes by helping people manage the disease and prevent/delay

complications. NYS Health Foundation advocates for development and

support of DSME programs, diabetes centers, community health workers, and

certified diabetes educators.

To reverse the diabetic epidemic in New York State, the NYSHealth established a

coordinated statewide response by establishing partnerships with health care organizations.8, 9

In 2009, The Institute for Leadership received a grant the purpose of which was to

advance one of the main objectives of the NYSHealth Diabetes Campaign: to mobilize

2 National Committee for Quality Assurance (NCQA) and Bridges to Excellence (BTE) are NYS Diabetes Campaign

partners. (more info can be obtained at: http://www.nysdiabetescampaign.org/partners/national-committee-quality-assurance and http://www.nysdiabetescampaign.org/partners/bridges-excellence

Khodenko 5

communities to spread programs that help prevent, identify, and manage diabetes in

workplaces and communities.

Bridges to Excellence (BTE) is a not-for-profit organization developed by employers,

physicians, health care services, researchers, and other industry experts. The goal is to

create significant improvements in the quality of care by recognizing and rewarding

health care providers who meet the objectives.

The Community Health Care Association of New York State (CHCANYS) is the

statewide primary care association of community with offices in Manhattan and Albany.

Until the launch of the campaign, many patients did not receive the care they needed in

order to manage diabetes effectively. In response, CHCANYS has joined the Campaign

as a cornerstone member of the Campaign’s Diabetes Clinical Improvement Network.

CHCANYS is working with the partners to design and implement strategies that enhance

diabetes care and improve patient outcomes.

The Healthcare Association of New York State (HANYS) represents approximately 550

not-for-profit and public hospitals, nursing homes, and home care organizations across

the State. HANYS joined the Campaign as a cornerstone member of the Campaign’s

Diabetes Clinical Improvement Network. Utilizing staff from its Quality Institute,

HANYS is working with the Campaign and other clinical partners to design and

implement strategies that enhance diabetes care and improve patient outcomes.

NCQA is a private, non-profit organization dedicated to improving health care quality.

NCQA accredits and certifies a wide range of health care organizations and recognizes

physicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information

Khodenko 6

Set (HEDIS) is the most widely used performance measurement tool in health care.

NCQA joined the Campaign to improve outcomes of patients with diabetes.

The New York Chapter of the American College of Physicians (NYACP) is the state’s

largest medical specialty organization representing 11,000 physicians. The Chapter

maintains a special focus on improving access and enhancing quality of care, promoting

public health and patient safety, providing continuing medical education, and promoting

the use of evidence-based practice guidelines. NYACP has joined the Campaign as a

cornerstone member of the Campaign’s Diabetes Clinical Improvement Network.

NYACP is working with partners to design and implement strategies that enhance

diabetes care and improve patient outcomes.

The New York State Academy of Family Physicians (NYSAFP) represents more than

4,300 family physicians and medical students throughout the State. Organization

provides education and advocacy among other activities. NYSAFP has joined the

Campaign and is working in partnership with other campaign members. NYSAFP has

worked with the Campaign’s Network partners to develop and launch a statewide

comprehensive survey to assess the needs of the primary care providers in caring for

their patients with diabetes.

As of today, New York State Diabetes Campaign is still in progress. What is

important is that success is being judged based on outcomes instead of the process and

structure of care!9 Many diabetes providers of excellence have received recognition for

achieving high standards of diabetes care under the National Committee for Quality

Assurance's Diabetes Recognition Program and/or Bridges to Excellence Diabetes Care, but

the full impact of the campaign is yet remains to be assessed.

Khodenko 7

Timeline

May 24, 2011 YMCA, BlueCross BlueShield, and Independent Health Announce New

Partnership in Buffalo to Combat Diabetes (Insurers to Reimburse Cost for Patients to Participate

in YMCA’s 16-week Diabetes Prevention Program; Reimbursement to Ensure Sustainability of

Program).

April 8, 2011 With 164,000 Brooklyn Residents Suffering from Diabetes, New York State

Health Foundation Brings Together Key Leaders to Take Action (NYSHealth Convenes

Borough Community to Highlight Growing Impact and Offer Ways the Community Can Combat

the Growing Epidemic).

August 30, 2010 NYSHealth Awards $375,000 Grant to YMCA for Diabetes Prevention

Program (In support of its $35 million, five-year diabetes campaign, the New York State Health

Foundation has awarded $375,000 to the New York State YMCA Foundation for community-

based diabetes prevention).

May 5, 2010 Empire BlueCross BlueShield Earns NYSHealth Endorsement for Program

Focused on Improving Care for Thousands Statewide (The New York State Health Foundation

(NYSHealth) has endorsed Empire BlueCross BlueShield for Empire’s new Quality-In-Sights®

Primary Care Incentive Program).

November 19, 2009 Former NBA All-Star, NYS Diabetes Campaign Urge Defensive Moves

Against Diabetes (Hall-of-Famer Dominique Wilkins and New York State Diabetes Campaign

Address Providers and Patients at Urban Health Plan in the Bronx).

November 7, 2009 Diabetes Fact Sheet (What is diabetes? Diabetes is a disease in which a

person’s body does not properly control the amount of sugar in the blood. This disease occurs

when the body fails to either produce enough insulin or use insulin properly. There are four

Khodenko 8

major types of diabetes: Type 1 diabetes mellitus, Type 2 diabetes mellitus, gestational diabetes

mellitus, and secondary diabetes).

November 2, 2009 New York State Diabetes Campaign Launches "Half the Care" (Media

Campaign Rallies Providers to Tackle the Diabetes Epidemic in New York State).

September 21, 2009 NYSHealth Launches "Diabetes Clinical Improvement Network" To

Improve Diabetes Outcomes Among Primary Care Providers Statewide (The New York State

Health Foundation (NYSHealth) announced today the launch of a Diabetes Clinical

Improvement Network as part of its New York State Diabetes Campaign to reverse the diabetes

epidemic).

July 23, 2009 New York State Health Foundation Announces Endorsement Program to

Recognize Health Plans With Effective Diabetes Incentive Programs (The New York State

Health Foundation (NYSHealth) announced that it is creating the “Diabetes Incentive Program

Endorsement” through its Diabetes Policy Center to recognize health plans that meet 10 criteria

for effective diabetes incentive and reward programs. These programs give physicians and

practices financial rewards if they demonstrate that they are delivering better care and achieving

better outcomes for patients. The program is part of the Foundation’s ongoing work to reverse

New York’s diabetes epidemic).

June 4, 2008 New York State Health Foundation Launches $35 Million Diabetes Campaign

(This landmark $35 million campaign will work to reverse New York's diabetes epidemic by

improving clinical care, mobilizing communities, and promoting policy. Dr. Neil Calman from

the Institute for Family Health will lead the initiative with the Foundation).

Khodenko 9

Graphs & Figures

Figure 1.

Graph 1.

Khodenko 10

$20

$91.8

$12

$45.2

$8

$46.4

$0

$10

$20

$30

$40

$50

$60

$70

$80

$90

$100

1980's 1990's

Total(direct & indirect)

Direct medical costs

Indirect costs

$132

$174

$92

$116

$40

$58

$0

$20

$40

$60

$80

$100

$120

$140

$160

$180

$200

2002 2007

Total (direct & indirect)

Direct medical costs

Indirect Costs

Costs in $ billions

Figure 2.

Figure 3.

Khodenko 11

Graph 2.

Khodenko 12

Bibliography

1. Prevention CfDCa. National Diabetes Fact Sheet: national estimates and general information on diabetes and prediabetes in the United States. Atlanta, GA: US Department of Health and Human Services, Center for Disease Control and Prevention; 2011 [updated 2011; cited 2011 02/22/11]; Available from: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf. 2. Prevention CfDCa. 2003 National Diabetes Fact Sheet. Center for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA: U.S. Department of Health and human Services, Center for disease Control and Prevention; 2003 [updated May 20, 2011; cited 2011 11/20/11]; Available from: http://www.cdc.gov/diabetes/pubs/estimates.htm. 3. Prevention CfDCa. National Diabetes Fact Sheet:general information and national estimates on diabetes in the United States. U.S. Department of Health and Human Services, Center for Disease Control and Prevention: Center for Disease Control and Prevention; 2005 [updated 2011; cited 2011 12/01/11]; Available from: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf. 4. Services USDoHaH. Redesigning the Health Care Team: Diabetes Prevention and Lifelong Management. Bethesda, Maryland: U.S. Department of Health and Human Services2011. 5. Prevention CfDCa. Long-Term Trends in Diabetes. U.S. Department of Health and Human Services, Center for Disease Control and Prevention: Center for Disease Control and Prevention; 2010 [updated October 2010; cited 2011 12/01/2011]; Available from: http://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf. 6. Boyle J, Honeycut, Amanda, Narayan, Venkat, Geiss, Linda, Chen, Hong, Thompson, Theodore. Projection of Diabetes Burden Through 2050. Diabetes Care. 2001; 24:1936-40. 7. Mainous A, Baker R, Koopman R, Saxena S, Diaz V, Everett C, et al. Impact of the population at risk of diabetes on projections of diabetes burden in the United States: an epidemic on the way. Diabetologia. 2007; 50:934-40. 8. Mathis A, Legendre Y, Montalvo W, Zahn D. Diabetes: A Hidden Health Care Cost Driver in New York. New York State: NYS Health Foundation2010 October, 2010. 9. Meyer H. New York State Health Foundation’s Diabetes Campaign Is Influencing Practices To Improve Care. Health Affairs. 2012; 31:240-4.