Proactive Diabetes Management: The New Normal in Value-Driven Care

According to the Centers for Disease Control and Prevention (CDC), chronic conditions are a leading driver in our nation’s healthcare costs. As spending in the United States (U.S.) continues to climb, we continue to shift our focus on how to best address this daunting issue. This shift moves away from a traditional fee-for-service model towards Value-Based Care (VBC). Essentially, this changes the way clinicians are reimbursed for providing care to their patients. Cleveland Clinic defines Value-Based Care as, “simply the idea of improving quality and outcomes for patients. Reaching this goal is based on a set of changes in the ways a patient receives care. Overall wellness, quality of care, and preventive screenings all are key to bringing about better outcomes.”

The Centers for Medicare & Medicaid Services (CMS), through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), introduced the Quality Payment Program (QPP). The QPP allows eligible clinicians to participate in two ways, through either the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs). Advanced models within the CMS Innovation Center (CMMI), “reward healthcare providers for delivering high-quality and cost-efficient care.” CMMI is aimed to develop and test new health payment and service delivery models to improve patient care, lower cost, and align systems to promote patient-centered practices. These models focus on innovation in areas such as episode-based care bundles, community wellness programs, and specific health conditions such as diabetes.

The Medicare Diabetes Prevention Program

One CMMI model, the Medicare Diabetes Prevention Program (MDPP), aims at changing the way Diabetes is managed. Diabetes impacts over 25% of Americans 65 years of age and older. It is also estimated, that in 2016, Medicare spent $42 billion more on patients with diabetes than it would have should those same patients not have had diabetes. These staggering numbers speak to the need not only to better manage patients with diabetes, but to be more proactive in the monitoring and APMs, preventing of patients progressing from prediabetes to type 2 diabetes. The MDPP aims to prevent type 2 diabetes when there is an indication of prediabetes. To provide services associated with the MDPP, eligible organizations must enroll as an MDPP Supplier. Once enrolled, MDPP suppliers can provide services, submit claims, and be provided payment. MDPP supplier organizations can use Certified Health IT, such as Practice Fusion EHR, to help identify and support managing patient’s diabetes.

Using Certified Health Technology to help achieve our goals

Practice Fusion provides the tools needed for both clinicians and patients to help prevent the progression of type 2 diabetes in prediabetic individuals. This begins with identifying patients within Practice Fusion who are eligible to participate in MDPP. To qualify for the program, with no cost sharing, patients must be deemed an eligible beneficiary. Practice Fusion helps to identify these patients through demographics as well as supported Clinical Decision Support (CDS) within the EHR. Once individuals are identified and enrolled, the use of Health IT supports the management of these participants through a variety of tools.

The U.S. healthcare system is the costliest in the world with expenditures only increasing. Like other system issues, we must address this problem with a multifactorial approach. As we continue with the move towards VBC, there is an opportunity to use Health IT in addressing this issue with a thoughtful and forward-thinking approach.

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